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Leeds 




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School of Medicine 



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University of Leeds by 

...Mr.s.^....H.,.....C.QlX.lnsQn 

m5. 



30106 004242664 



BLOOD-PRESSURE 

IN 

SURGERY 

AN EXPERIMENTAL AND CLINICAL RESEARCH 



THE CART WRIGHT PRIZE ESSAY 
FOR igoj 



GEORGE W.^CRILE. A.M., M.D. 

PROFESSOR OF CLINICAL SURGERY, WESTERN RESERVE MEDICAL COLLEGE ; 

SURGEON TO ST. ALEXIS HOSPITAL ; ASSOCIATE SURGEON TO 
LAKESIDE HOSPITAL, CLEVELAND 




J. B. 



PHILADELPHIA AND LONDON 

LIPPINCOTT COMPANY 
1903 



Copyright, 1903, by George W. Crile 




PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA, U.S.A. 



<;04554 



Digitized by the Internet Archive 

in 2015 



https://archive.org/details/b21 51 0842 



June 27, 1903. 

Dr. George W. Crile, 

275 Prospect Street, 

Cleveland, Ohio. 
My dear Doctor, — -I have the honor to inform you that the 
Cartwright Prize of the Alumni Association of the College of Physi- 
cians and Surgeons, New York City, has been awarded to your 
essay entitled "Blood-Pressure in Surgery," and designated "G. B." 

Yours truly, 

HENRY E. HALE, 

Secretary A btiiini Association. 



PREFACE 



In all the experiments the animals were completely an- 
esthetized. But one reco^'ery experiment was made. This 
animal was kept under the influence of morphin until it was 
killed. This research opened so many leads that a large num- 
ber of experiments became necessary to bring it to even so 
imperfect a close. I have pleasure in making most grateful 
acknowledgment of invaluable aid in the form of suggestions 
and criticisms from Professor George N. Stewart and Pro- 
fessor Torald Sollman, both of whom at all times generously 
gave me the benefit of their wide experience and scientific 
knowledge. To my pupil, Mr. Homer H. Heath, who dis- 
played commendable originality during the research, the re- 
sponsible task of collecting the major portion of the experi- 
mental data was intrusted. In the collection of this data other 
pupils, Mr. Lenhart and Mr. Worth Brown, rendered valuable 
assistance. To my associate. Dr. William E. Lower, I am in- 
debted for many valuable suggestions, criticisms, and aid in 
both the experimental and the clinical research. To my clinical 
assistant, Dr. Clyde E. Ford, was intrusted the collection of 
the larger portion of the clinical data on the human blood- 
pressure, and a portion of the experimental work. Dr. A. 
Cudell undertook the preparation of the historical notes. To 
the Board of Trustees of Lakeside Hospital I am under obli- 
gation for arranging and placing at my disposal a special 
pneumatic room. 



I 



TABLE OF CONTENTS 



PAGE 

Introduction 9 

Methods of Investigation and Annotation ii 

Protocols 13 

Summary of Experimental Data 261 

Alcohol 261 

Nitroglycerin and Amyl Nitrite 262 

Digitalis 263 

Strychnin 265 

Saline Infusion 269 

Adrenalin, Historical Account of 270 

Morphin 281 

On the Mixed Effects of Certain Drugs 281 

Preliminary Resection or Cocainization of Stellate Ganglia as a 

Means of preventing Shock 282 

On the Effect of Pressure upon the Circulation 282 

On the Effect of Increased Pressure upon Absorption 286 

On the Effect of alternately and simultaneously varying the 
Pressure of the Inspired Air and the Pressure upon the Re- 
mainder of the Body 286 

Mechanical Pressure 288 

The Pneumatic Rubber Suit 288 

On the Resuscitation of Animals Apparently Dead 291 

Clinical Observations on Blood- Pressure 300 

A Study of the Changes in the Blood-Pressure during Surgical 

Operations 362 

Operations on the Head 362 

Operations in the Mouth 367 

Operations on the Neck 367 

Operations on the Thorax 376 

Operations on the Abdomen 378 

Operations on the Genito-Urinary System 385 

Operations on the Testicles 385 

Operations on the Spinal Column 385 

Herniotomy 393 

Operations upon the Extremities 393 

Operations under Cocain 399 

Summary 399 

Argument 401 

Collapse 410 

Final Summary 412 

3 



LIST OF ILLUSTRATIONS 



FIG. PAGE 

1. Alcohol in a normal animal 13 . 

2. Alcohol in shock 15 

3. Nitroglycerin 33 

4. Digitalis administered to a normal animal 45 

, 5. Intravenous injection of digitalis after severing the spinal cord. ... 46 

6. Intravenous injection of digitalis in shock 51 

7. Intravenous injection of digitalis, normal animal 58 

8. Intravenous injection of strychnin, animal in moderate shock 71 

9. Strychnin convulsions 72 

10. Intravenous injection of strychnin in collapse from asphyxia 88 

11. Administration of adrenalin in shock 95 

12. Intravenous injection of strychnin in shock, the vagi and accele- 

rantes having been severed 97 

13. Intravenous injections of strychnin, the vagi and accelerantes 

having been severed loi 

14. Intravenous injections of strychnin, the vagi and accelerantes 

having been severed 102 

15. Intravenous injections of strychnin, the vagi and accelerantes 

having been severed 103 

16. Intravenous injections of strychnin in shock, the vagi and accele- 

rantes having been severed 106 

17. Intravenous injections of strychnin in shock, the vagi and accele- 

rantes having been severed 108 

18. Intravenous injection of strychnin in severe hemorrhage ill 

19. Simultaneous administration of digitalis, bandaging and strychnin 138 

20. Administration of adrenalin in profound shock 151 

21. Administration of adrenalin in profound shock 157 

22. Administration of adrenalin in decapitated animal 160 

23. Administration of adrenalin in decapitated animal 161 

24. Administration of adrenalin in decapitated animal 163 

25. Administration of adrenalin in decapitated animal 164 

26. Administration of strychnin; medulla cocainized 167 

27. Administration of strychnin; medulla cocainized 169 

28. Adminstration of strychnin and adrenalin ; medulla and cord co- 

cainized 171 

29. Pneumatic, arterial, and intra-thoracic pressure 176 

30. Pneumatic, arterial, and intra-thoracic pressure 182 

31. Pneumatic pressure, spinal cord severed 183 

32. Pneumatic pressure, normal animal 186 

33. Shock, external respiration, pneumatic pressure 187 

5 



6 LIST OF ILLUSTRATIONS. 

FIG. PAGE 

34. Shock, bandaging 192 

35- Normal animal, carotid arteries ligated, pneumatic pressure 194 

36. Positive and negative atmospheric pressure 195 

37. Moderate shock, pneumatic pressure 199 

38. Increased pressure within the alveoli of the lungs 200 

39. Pneumatic pressure, external respiration 203 

40. Normal animal, pneumatic pressure 204 

41. Varying pneumatic pressure in moderate shock 206 

42. Varying pneumatic pressure on a dead animal 207 

43. Positive and negative pneumatic pressure 208 

44. Air exhausted from the lungs 212 

45. Moderate shock, pneumatic pressure 222 

46. Asphyxia, resuscitation of animal 260 

47. Pneumatic rubber suit 289 

48. Hurthle apparatus schematic 302 

49. Hurthle apparatus schematic 302 

50. Hurthle apparatus 303 

51. Hoepfle, blood-pressure apparatus 304 

52. Air-tube and clamp, Riva Rocci sphygmomanometer 305 

53. Riva Rocci sphygmomanometer with Hill-Barnard arm attachment 305 

54. Hill-Barnard sphygmomanometer 307 

55. Oliver's hemadynamometer 307 

56. Oliver's hemadynamometer, mode of applying to the radial artery 308 

57. Oliver's hemadynamometer, mode of applying to the carotid artery 309 

58. Oliver's hemadynamometer, determining venous pressure 309 

59. Gaertner tonometer 310 

60. Stanton's method for the determination of blood-pressure 311 

61. Basch sphygmomanometer 315 

62. Basch manometer 316 

63. Physiological variations in blood-pressure 334 

64. Effects of movement, on blood-pressure 336 

65. Abdominal operations for tubercular peritonitis 356 

66. Blood-pressure and pulse-rate curve during a Halsted operation. .. 357 

67. Operations upon the cranium , 363 

68. Operations upon the brain 364 

69. Excision of the Gasserian ganglion 365 

70. Excision of the Gasserian ganglion 366 

71. Case of extreme asphyxia 369 

72. Moderate shock, pneumatic suit applied 370 

73. Pneumatic suit in shock 371 

74. Manipulation of superior laryngeal nerve 372 

75. Removal of tumor of the parotid 373 

76. Removal of tumor of neck and upper thorax 375 

77. Amputation of breast 377 

78. Operation for empyema 379 

79. Operation for gall-stones 380 

80. Operation on the gall-bladder under cocain 381 



LIST OF ILLUSTRATIONS. 7 

FIG. PAGE 

81. Operation upon the gall-bladder 383 

82. Removal of an ovarian cyst 384 

83. Divulsion of sphincter ani 386 

84. Nephrectomy 387 

85. Operation upon testicles 388 

86. Operation upon testicles 389 

87. Operation for inflamed hydrocele 390 

88. Amputation of penis 391 

89. Exploration of spinal cord 392 

90. Herniotomy 394 

91. Stretching sciatic nerve 395 

92. Operation for removing necrosed bone 396 

93. Traumatic shock 397 

94. Collapse 398 



t 



I 



INTRODUCTION 



Investigation of the views as to the various causes of low 
blood-pressures in surgical cases, and of the methods em- 
ployed in controlling the same in the various clinics of the 
surgical world, reveals a diversity of opinion as to the former 
and a diversity of method as to the latter. One may say, in 
fact, that each surgeon holds distinctive opinions. On a closer 
inquiry as to the foundations of belief, it is often found to 
have taken its origin as a tradition handed down by predeces- 
sors in a hospital service, or from master to pupil, and accepted 
in the same way as religion or politics. This is not advanced 
as an argument for or against the correctness of the beliefs, 
but indicates that the matter has been placed upon an empiric 
rather than a scientific basis. 

The most striking fact with regard to this is the contradic- 
tory methods of treatment : one surgeon gives alcohol as a 
routine after severe operations; another, both before and 
after; while another never gives it. One gives digitalis, 
another strychnin ; some give strychnin and its antagonist, 
nitroglycerin, at the same time. Some give hypodermic injec- 
tions of ether, even if ether anesthesia has been employed; 
atropin, because the circulation in the skin may be increased, 
thereby removing the symptom of coldness of the skin. An- 
other gives caffein, because it stimulates the heart. In France 
ergotin is the favorite ; in Germany, strychnin. Almost every 
known drug is given; synergists and antagonists simultane- 
ously, while some surgeons give no drugs. 

A closer comparison between results in wards in which 
stimulation, particularly " heavy" stimulation, is the rule, and 
in wards in which it is the exception, is not unfavorable to 
the latter. 

Nitroglycerin, atropin, saline infusion, digitalis, alcohol, 

9 



lO 



INTRODUCTION. 



caffein, camphor, ergotin, ether, strophanthus, etc., have so 
many individual, even contradictory, actions that it would seem 
that these drugs could not all be indicated in the same condi- 
tion. In selecting one of these drugs in a case of shock or 
collapse, would it not first be necessary to know definitely 
to what the fall in the blood-pressure is due? Is it due to 
the exhaustion of the anatomical periphery (blood-vessels) ; 
of the heart; of the vasomotor; of the cardiac centre; or of 
the respiratory centre; is it an exhaustion or a suspension of 
function, or has the blood plasma passed through the vessel 
walls? If it is due to exhaustion of one or more of these cen- 
tres or organs, would stimulation relieve the exhaustion, or 
would an increased exhaustion follow the stimulation ? Would 
it be better to lash the tired horse or give it rest? 

If not all the centres and organs are exhausted, would it 
be advantageous to stimulate those not affected while the ex- 
hausted ones rested? Would it be advantageous to restore 
the blood-pressure, as far as possible, by use of harmless me- 
chanical means? 

Are not the centres governing the circulation automatic, 
and are they not all automatically stimulated? And are they 
not all stimulated to the point of exhaustion before the final 
circulatory break-down occurs ? As applied to the centres that 
are depressed, is it better to depend upon a drug stimulation, 
or upon automatic stimulation? 

These questions have prompted this research, the results of 
which were continually subjected to a clinical comparison in 
an active surgical practice. Much of the experimental data 
might have been omitted, publishing instead only illustrative 
experiments and the summaries, but the task of making so 
large a number of experiments is so costly in time and labor 
that it was thought best to publish all the data for the benefit 
of some future investigator, who may be spared many weary 
details by making use of the data our research has yielded. 



METHODS OF INVESTIGATION 
AND ANNOTATION 



The animals were all reduced to full surgical anesthesia 
before the experiments were begun, and were killed before re- 
covery from the same. In the greater number of experiments 
ether was used, and anesthesia was produced by the following 
method. A cloth hood, conical in shape, was constructed so 
as to accommodate the animal's entire head, and into the apex 
was thrust a piece of cotton wool. Saturating the cotton with 
the anesthetic and holding the hood closely over the head of 
the animal, reduction to surgical anesthesia was made with 
but little difficulty. After the completion of the anesthesia, 
the trachea was exposed and a breathing cannula inserted. To 
the free end of this cannula a strong rubber tubing was at- 
tached, and to the end of this tubing was fastened a funnel 
which was placed over a piece of cotton wool saturated with 
the anesthetic. By this method anesthesia was easily main- 
tained and no impediment offered to free respiration. The 
blood-pressure was recorded in the usual way, by means of 
mercury manometers upon a revolving drum, carrying a 
smoked paper, according to the methods in vogue in experi- 
mental physiology. The drums were revolved by mechanisms 
so made as to be capable of a variety of movements, ranging 
from one revolution in thirty minutes to eighteen revolutions 
per minute, so that any phase of a given tracing might be 
duly recorded. In every experiment tracings were taken, and 
these have been carefully preserved. Accordingly there is no 
statement made in the following pages that may not be veri- 
fied by tracings in my possession. A sufficient number of 
typical ones have been published to illustrate groups of their 

kind. The number of animals subjected to experiment was 

1 1 



12 



METHODS OF INVESTIGATION. 



two hundred and fort3^-three, and complete notes of all the 
experiments have been preserved. The notes were made 
ahvays at the time of the experiment, and every detail was 
carefully recorded. It is from these notes and the tracings 
that the material for the following pages was obtained. No 
matter how faithfully the notes and the illustrations may have 
been made, it is impossible to impart the full impression made 
by the experiments upon the experimenter, who received the 
impressions at first hand. In the experiments made in one 
year the metric system was employed, while in the later ones 
it was not. The confusion was unfortunately overlooked until 
the manuscript had been set up. 



BLOOD-PRESSURE IN 

SURGERY 



Experiment 1. 
Alcohol. 

Mongrel puppy; weight, three kilos. Morphin and 
ether anesthesia. 



Fig. I. — Exp. i. — Alcohol administered to a normal animal. A, carotid pressure ; B, res- 
piration ; C, seconds. Note the immediate fall in blood-pressure, and the compensatory rise 
on the intravenous administration of alcohol. 



At 1 2. 20, blood-pressure, 95 mm.; pulse, 186; respiration, 52. 



Ten minims of whiskey were injected intravenously. 
No effect was produced. A repetition of the injec- 
tion caused no change. An injection of 20 minims 
of whiskey was followed by a slight irregularity in 
the blood-pressure. 





A 



B 



c 



7 



ON THE BLOOD-PRESSURE IN SURGERY. 



At 12.25, blood-pressure, 95 nim. ; pulse, 162; respiration, 42. 

An injection of 20 minims of whiskey was followed 
by a marked irregularity and fall in the blood-press- 
ure. 

At 12.28, blood-pressure, 80 mm. ; pulse, 144; respiration, 60. 

At 12.30,20 minims of whiskey were injected. An irregular- 
ity in the blood-pressure followed. 

At 12.31, blood-pressure, 80 mm.; pulse, 144; respiration, 60. 

At 12.35, blood-pressure, 95 mm. ; pulse, 172; respiration, 60. 

At 12.37, ^^"i injection of 20 minims of whiskey was given. An 
irregularity in the blood-pressure followed. 

At 12.38, blood-pressure, 85 mm. 

At 12.42, blood-pressure, 95 mm. ; pulse, 172; respiration, 60. 

Experiment 2. 
Alcohol. 

Dog ; good condition ; weight, five kilos. Ether an- 
esthesia. 

At 10. 12, initial blood-pressure, 120 mm.; pulse, 160; stroke, 
15 mm. An injection of 22 minims of whiskey was 
given into the femoral vein. It was observed that 
raising the animal's legs caused the blood-pressure 
to fall with a return to the former level. 

At 10. 14, blood-pressure, 100 mm. ; pulse, 148; stroke, 13 mm. 

At 10.15.30, 22 minims of whiskey were injected into the fem- 
oral vein. 

At 10. 16.30, blood-pressure, 90 mm.; pulse, 124; stroke, 18 
mm. 

At 10.18, 22 minims of whiskey were injected. A gradual fall 
in the blood-pressure, Avith slowed respiration, fol- 
lowed until death. Death was due to respiratory 
failure. 

Experiments 3, 4, 5. 
Alcohol. 



Dog I, male mongrel; excellent condition; weight, 
sixteen kilos. 




Dog 3, male mongrel ; excellent condition ; weight, 
nine kilos. The tracheal and carotid cannula were 
applied. Ether anesthesia. 



l6 ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.05, dog I' blood-pressure, 140 mm.; stroke, 12 mm.; 
pulse, 140; respiration, 80. 

Dog 2, blood-pressure, 112 mm.; stroke, 13 mm.; 
pulse, 156; respiration, 80. 

Dog 3, blood-pressure, 98 mm.; stroke, 18 mm.; 
pulse, 152; respiration, 10. 
At 12.45, tbe animal was reduced to shock by skinning and 
irritating the denuded surfaces. 

Dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 
pulse, 144; respiration, 92. 

Dog 2, blood-pressure, 95 mm. ; stroke, 18 mm. ; 
pulse, 132; respiration, 76. 

Dog 3, blood-pressure, 50 mm. ; stroke, 20 mm. ; 
pulse, 128; respiration, 52. 

In dogs I and 2 the sciatics were electrically stimu- 
lated. A sharp fall was recorded, followed by a 
gradual rise. 

In dog 3 a sharp rise and fall, with a gradual return 
to the former level, was noted. 
At 12.50, dog I, blood-pressure, 125 mm.; stroke, 10 mm.; 
pulse, 132; respiration, 88. 

Dog 2, blood-pressure, 80 mm.; stroke, 18 mm.; 
pvilse, 132; respiration, 72. 

Dog 3, blood-pressure, 70 mm.; stroke, 16 mm.; 

pulse, 132; respiration, 56. 
From 12.51 to 12.53 an injection of 22 minims of whiskey 

was administered. An increased pulse-rate, slower 

respiration, and a rise in the blood-pressure in each 

animal followed. 
At 12. 54, dog I, blood-pressure, 130 mm.; stroke, 16 mm.; 

pulse, 148; respiration, 68. 

Dog 2, blood-pressure, 75 mm.; stroke, 18 mm.; 
pulse, 160; respiration, 60. 

Dog 3, blood-pressure, 70 mm.; stroke, 18 mm.; 
pulse, 148; respiration, 48. 
At 12.55, the sciatics were stimulated, with results similar to 
the previous stimulation. 



ON THE BLOOD-PRESSURE IN SURGERY. 17 

At 1. 02, dog I, blood-pressure, 110 mm.; stroke, 12 mm.; 
pulse, 148; respiration, 76. 

Dog 2, blood-pressure, 75 mm.; stroke, 19 mm.; 
pulse, 144; respiration, 56. 

Dog 3, blood-pressure, 80 mm.; stroke, 16 mm.; 
pulse, 144; respiration, 48. 
At 1.02.30, dog I, an injection of 22 minims of whiskey was 
administered. 

At 1.03.30, dog 2, an injection of 22 minims of whiskey was 
administered. 

At 1.03.45, dog 3, an injection of 22 minims of whiskey was 
administered. 

At 1.05, dog I, blood-pressure, 115 mm.; stroke, 12 mm.; 
pulse, 148; respiration, 64. 

Dog 2, blood-pressure, 70 mm. ; stroke, 20 mm. ; 
pulse, 168; respiration, 52. 

Dog 3, blood-pressure, 80 mm.; stroke, 16 mm.; 
pulse, 152; respiration, 44. 
At 1.08, the sciatics were electrically stimulated; the results 
were as before. 

At 1. 1 3, dog I, blood-pressure, 112 mm.; stroke, 10 mm.; 
pulse, 144; respiration, 80. 

Dog 2, blood-pressure, 70 mm.; stroke 12 mm.; 
pulse, 152; respiration, 52. 

Dog 3, blood-pressure, 75 mm.; stroke, 13 mm.; 
pulse, 132; respiration, 48. 

An injection of 22 minims of whiskey was adminis- 
tered in dogs I, 2, and 3. The results were as fol- 
lows : 

Dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 
pulse, 144; respiration, 68. 

Dog 2, blood-pressure, 68 mm. ; stroke, 10 mm. ; 
pulse, 152; respiration, 52. 

Dog 3, blood-pressure, 80 mm.; stroke, 13 mm.; 
pulse, 132; respiration, 44. 
At 1. 38, dog I, blood-pressure, 118 mm.; stroke, 10 mm.; 
pulse, 150; respiration, 60. 



l8 ON THE BLOOD-PRESSURE IN SURGERY. 

Dog 2, blood-pressure, 60 mm. ; stroke, 1 1 mm. ; 
pulse, 156; respiration, 64. 

Dog 3, blood-pressure, 74 mm.; stroke, 17 mm.; 
pulse, 1 52 ; respiration, 48. 
At 1. 38. 15, dog I, an injection of 22 minims of whiskey was 
administered. 

At 1.38.30, dog 2, an injection of 22 minims of whiskey was 
administered. 

At 1.39, dog 3, an injection of 22 minims of whiskey was ad- 
ministered. 

At 1. 4 1, dog I, blood-pressure, 115 mm.; stroke, 11 mm.; 
pulse, 144; respiration, 68. 

Dog 2, blood-pressure, 60 mm. ; stroke, 8 mm. ; 
pulse, 156; respiration, 52. 

Dog 3, blood-pressure, 70 mm.; stroke, 16 mm.; 
pulse, 112; respiration, 144. 
At 1.43, electrical stimulation of the sciatics was made, with 
former results. 

At 1.52.30, dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 
pulse, 156; respiration, 64. 

Dog 2, blood-pressure, 70 mm. ; stroke, 8 mm. ; 
pulse, 156; respiration, 52. 

Dog 3, blood-pressure, 55 mm.; stroke, 16 mm.; 
pulse, 96; respiration, 40. 
At 1.53. 15, dog I, an injection of 22 minims of whiskey was 
administered. 

At 1.54, dog 2, an injection of 22 minims of whiskey was ad- 
ministered. 

At 1.55, dog 3, an injection of 22 minims of whiskey was ad- 
ministered. 

At 1. 56, dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 
pulse, 160; respiration, 68. 

Dog 2, blood-pressure, 70 mm. ; stroke, 8 mm. ; pulse, 
156; respiration, 56. 

Dog 3, blood-pressure, 60 mm.; stroke, 10 mm.; 
pulse, 96; respiration, 40. 
At 1. 58, the sciatics were electrically stimulated. The results 
were not so marked as formerly. 



ON THE BLOOD-PRESSURE IN SURGERY. ig 

At 2.05, dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 
pulse, 152; respiration, 68. 

Dog 2, blood-pressure, 75 mm.; stroke, 10 mm.; 
pulse, 142; respiration, 52. 

Dog 3, blood-pressure, 35 mm. ; stroke, 18 mm. ; 
pulse, 108 ; respiration, 36. 

Dog I, an injection of 22 minims of whiskey was 
given. 

At 2.05.30, dog 2, an injection of 22 minims of whiskey was 
given. 

At 2.06.30, dog 3, an injection, of 22 minims of whiskey was 
given. 

At 2.08, dog I, blood-pressure, 118 mm.; pulse, 156; respi- 
ration, 56. 

Dog 2, blood-pressure, 78 mm.; stroke, 10 mm.; 
pulse, 152; respiration, 52. 

Dog 3, blood-pressure, 55 mm.; stroke, 16 mm.; 
pulse, 96; respiration, 36. 
At 2.19, dog I, blood-pressure, iii mm.; stroke, 8 mm.; 
pulse, 160; respiration, 56. 

Dog 2, blood-pressure, 88 mm.; stroke, 19 mm.; 
pulse, 156; respiration, 44. 

Dog 3, blood-pressure, 55 mm.; stroke, 14 mm.; 
pulse, 100; respiration, 36. 
At 2.19.30, clog I, an injection of 22 minims of whiskey was 
given. 

At 2.20, dog 2, an injection of 22 minims of whiskey was 
given. 

At 2.21, dog 3, an injection of 22 minims of whiskey was 
given. 

At 2.22, dog I, blood-pressure, 118 mm.; stroke, 10 mm.; 
pulse, 160; respiration, 72. 

Dog 2, blood-pressure, 84 mm. ; stroke, 9 mm. ; 
pulse, 148; respiration, 56. 

Dog 3, blood-pressure, 60 mm.; stroke, 16 mm.; 
pulse, 60; respiration, 36. 
At 3.02, dog I, blood-pressure, 100 mm.; stroke, 8 mm.; 
pulse, 60; respiration, 70. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Dog 2, blood-pressure, 70 mm. ; stroke, 8 mm. ; 
pulse, 156; respiration, 52. 

Dog 3, blood-pressure, 55 mm.; stroke, 16 mm.; 

pulse, 56; respiration, 40. 
At 3.55. 15, an injection of 22 minims of whiskey was admin- 

tered to dogs i, 2, and 3. 
At 3.56, dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 

pulse, 160; respiration, 68. 

Dog 2, blood-pressure, 70 mm. ; stroke, 8 mm. ; 
pulse, 156; respiration, 56. 

Dog 3, blood-pressure, 60 mm.; stroke, 10 mm.; 

pulse, 56; respiration, 40. 
At 3.58, electrical stimulation was applied to the sciatic nerve. 

Not so active a vasomotor mechanism was observed 

as in previous stinudations. 
At 4.05, dog I, blood-pressure, 115 mm.; stroke, 10 mm.; 

pulse, 152; respiration, 68. 

Dog 2, blood-pressure, 75 mm. ; stroke, 10 mm. ; 
pulse, 142; respiration, 52. 

Dog 3, blood-presssure, 55 mm.; stroke, 18 mm.; 
pulse, 100; respiration, 36. 

At 4.06, an injection of 22 minims of whiskey was adminis- 
tered to dogs 1,2, and 3. 

At 4.08, dog I, blood-pressure, 118 mm.; stroke, 11 mm.; 
pulse, 156; respiration, 56. 

Dog 2, blood-pressure, 78 mm.; stroke, 10 mm.; 
pulse, 152; respiration, 52. 

Dog 3, blood-pressure, 58 mm. ; stroke, 9 mm. ; 
pulse, 100; respiration, 36. 
At 4. 19, dog I, blood-pressure, iii mm.; stroke, 8 mm.; 
pulse, 160; respiration, 56. 

Dog 2, blood-pressure, 88 mm. ; stroke, 9 mm. ; 
pulse, 156; respiration, 44. 

Dog 3, blood-pressure, 55 mm. ; stroke, 14 mm. ; 
pulse, 100; respiration, 36. 
At 4.20, an injection of 22 minims of whiskey was adminis- 
tered to dogs I, 2, and 3. 



ON THE BLOOD-PRESSURE IN SURGERY. 21 

At 4.22, dog I, blood-pressure, 118 mm.; stroke, 10 mm.; 
pulse, 160; respiration, 72. 

Dog 2, blood-pressure, 84 mm. ; stroke, 9 mm. ; 
pulse, 148; respiration, 56. 

Dog 3, blood-pressure, 55 mm.; stroke, 12 mm.; 
pulse, 132; respiration, 40. 
At4.48.15, dog I, blood-pressure, 114 mm.; stroke, 8 mm.; 
pulse, 156; respiration, 64. 

Dog 3, blood-pressure, 60 mm.; stroke, 12 mm.; 
pulse, 128; respiration, 40. 

At 4.49.45, an injection of 22 minims of whiskey was adminis- 
tered to dogs 1,2, and 3. 

At 4.50.45, dog I, blood-pressure, 121 mm.; stroke, 8 mm.; 
pulse, 172; respiration, 68. 

Dog 2, blood-pressure, 75 mm. ; stroke, 7 mm. ; 
pulse, 144; respiration, 52. 

Dog 3, blood-pressure, 60 mm. ; stroke, 1 1 mm. ; 

pulse, 120; respiration, 44. 
At 4.52, the sciatics were stimulated. The results were as in 

the last observation. 
At 5.03, dog I, blood-pressure, 120 mm.; stroke, 9 mm.; 

pulse, 144; respiration, 68. 

Dog 2, blood-pressure, 75 mm. ; stroke, 9 mm. ; 
pulse, 144; respiration, 52. 

Dog 3, blood-pressure, 62 mm. ; stroke, 1 1 mm. ; 
pulse, 120; respiration, 44. 

At 5.04, an injection of 22 minims of whiskey was adminis- 
tered to dogs 1,2, and 3. 

At 5.07, dog I, blood-pressure, 130 mm.; stroke, 11 mm.; 
pulse, 168; respiration, 60. 

Dog 2, blood-pressure, 74 mm. ; stroke, 8 mm. ; 
pulse, 148; respiration, 48. 

Dog 3, blood-pressure, 65 mm.; stroke, 10 mm.; 
pulse, 96; respiration, 36. 
At 5.26.30, dog I, blood-pressure, 120 mm.; stroke, 8 mm.; 
pulse, 160; respiration, 66. 

Dog 2, blood-pressure, 80 mm.; stroke, 10 mm.; 
pulse, 152; respiration, 56. 



22 ON THE BLOOD-PRESSURE IN SURGERY. 

Dog 3, blood-pressure, 65 mm. ; stroke, 8 mm. ; 
pulse, 100; respiration, 40. 

At 5.27.30, an injection of 22 minims of whiskey was adminis- 
tered to dogs 1,2, and 3. 

At 5.30, dog I, blood-pressure, 123 mm.; stroke, 10 mm.; 
pvtlse, 153, respiration, 72. 

Dog 2, blood-pressure, 74 mm. ; stroke, 10 mm. ; 
pulse, 132; respiration, 56. 

Dog 3, blood-pressure, 70 mm. ; stroke, 8 mm. ; 

pulse, 88; respiration, 40. 
At 5.31, electrical stimulation was applied to the sciatics. The 

usual effect was noted. 
At 5.35, the animals were killed with intravenous injections of 

MgS04. 

Experiments 6, 7, 8. 
Alcohol. 

Dog I, female mongrel; good condition; weight, 
eight kilos. 

Dog 2, female mongrel ; good condition ; weight, 
ten kilos. 

Dog 3, female mongrel; good condition; weight, 
eleven kilos. Ether anesthesia. The tracheal and 
carotid cannulse were adjusted. 
At 10.45, dog i> blood-pressure, 125 mm.; stroke, 19 mm.; 
pulse, 156; respiration, 40. 

Dog 2, blood-pressure, 110 mm.; stroke, 10 mm.; 
pulse, 136; respiration, 68. 

Dog 3, blood-pressure, 138 mm.; stroke, 6 mm.; 
pulse, 144; respiration, 84. 

The animals were reduced to shock by skinning, then 
sponging the denuded surfaces. 

Dog I, blood-pressure, 96 mm.; stroke, 18 mm.; 
pulse, 132; respiration, 40. 

Dog 2, blood-pressure, 70 mm. ; stroke, 9 mm. ; 
pulse, 124; respiration, 64. 

Dog 3, blood-pressure, 90 mm.; stroke, 10 mm.; 
pulse, 124; respiration, 72. 



ON THE BLOOD-PRESSURE IN SURGERY. 23 

At 1 1. 10, electrical stimulation was applied to the sciatics. The 
results were as follows : 

Dog I, a gradual rise was obtained in the blood- 
pressure. 

Dog 2, a sharp rise in the blood-pressure, with a cor- 
responding fall, was recorded. 

Dog 3, a slight fall occurred in the blood-pressure, 
followed by a gradual rise. 
At 1 1.23.45, dog I, respirations failed. Artificial respirations 
were begun. 

At 11.24, 22 minims of whiskey were injected in dogs 2 and 3. 

Prior to the injections, the following observations 
were made: 

Dog 2, blood-pressure, 85 mm. ; stroke, 8 mm. ; 
pulse, 124; respiration, 56. 

Dog 3, blood-pressure, 102 mm.; stroke, 6 mm.; 
pulse, 120; respiration, 64. 
At 1 1.26, the observations after the injection were as follows : 
Dog 2, blood-pressure, 96 mm. ; stroke, 10 mm. ; 
pulse, 120; respiration, 56. 

Dog 3, blood-pressure, 120 mm.; stroke, 8 mm.; 
pulse, 108; respiration, 65. 
At 11.28.45, the sciatics of dogs i, 2, and 3 were stimulated. 

Dog I had now recovered. The stimulation was fol- 
lowed by a rise then a fall in the blood-pressure. 
Dog 2, there was an irregular rise and fall in the 
blood-pressure. 

Dog 3, a slight fall occurred in the blood-pressure, 
followed by a gradual rise. 
At 1 1.36. 15, dog I, blood-pressure, no mm. ; stroke, 20 mm. ; 
pulse, 160; respiration, 48. 

Dog 2, blood-pressure, 90 mm.; stroke, 10 mm.; 
pulse, 128; respiration, 52. 

Dog 3, blood-pressure, 95 mm. ; stroke, 10 mm. ; 
pulse, 116; respiration, 72. 
At 1 1. 37, dogs I, 2, and 3 were injected with 22 minims of 
whiskey. 



24 ON THE BLOOD-PRESSURE IN SURGERY. 

At 1 1.40, dog I, blood-pressure, 130 mm.; stroke, 28 mm.; 
pulse, 136; respiration, 36. 

Dog 2, blood-pressure, 94 mm.; stroke, 10 mm.; 
pulse, 128; respiration, 48. 

Dog 3, blood-pressure, no mm.; stroke, 10 mm.; 
pulse, 112; respiration, 68. 
At 12.05, dog I) blood-pressure, no mm.; stroke, 12 mm.; 
pulse, 128; respiration, 48. 

Dog 2, blood-pressure, 90 mm.; stroke, 10 mm.; 
pulse, 140; respiration, 48. 

Dog 3, blood-pressure, no mm.; stroke, 9 mm.; 
pulse, 132; respiration, 76. 
At 12.05.30, dogs I, 2, and 3 were injected with 22 minims of 
whiskey. 

Dog I, blood-pressure, iii mm.; stroke, 19 mm.; 
pulse, 153; respiration, 40. 

Dog 2, blood-pressure, 92 mm. ; stroke, 10 mm. ; 
pulse, 140; respiration, 52. 

Dog 3, blood-pressure, 112 mm.; stroke, 10 mm; 
pulse, 132; respiration, 72. 
At 12.08, the sciatics were stimulated. 

Dogs I and 2 showed a slight response in the blood- 
pressure. 

In dog 3 there was a slight fall in the blood-pressure, 
with a gradual recovery. 
At 12.16, dog I, blood-pressure, no mm.; stroke, 19 mm.; 
pulse, 132; respiration, 36. 

Dog 2, blood-pressure, 88 mm. ; stroke, 8 mm. ; 
pulse, 124; respiration, 56. 

Dog 3, blood-pressure, 102 mm.; stroke, 11 mm.; 
pulse, 116; respiration, 64. 
At 12.17.45, dogs I, 2, and 3 were injected with 22 minims of 
whiskey. 

At 12.20.30, dog I, blood-pressure, 105 mm.; stroke, 18 mm.; 
pulse, 124; respiration, 36. 

Dog 2, blood-pressure, 95 mm. ; stroke, 1 1 mm. ; 
pulse, 116; respiration, 56. 



ON THE BLOOD-PRESSURE IN SURGERY. 25 

Dog 3, blood-pressure, 100 mm. ; stroke, 10 mm. ; 
pulse, 112; respiration, 64. 
At 12.21.30, the sciatics were stimulated; very slight reaction 
was obtained. 

At 12.31, dog I, blood-pressure, no mm.; stroke, 18 mm.; 
pulse, 128; respiration, 44. 

Dog 2, blood-pressure, 81 mm.; stroke, 8 mm.; 
pulse, 108; respiration, 52. 

Dog 3, blood-pressure, loi mm.; stroke, 10 mm.; 
pulse, 116; respiration, 64. 

At 12. 32, an injection of 22 minims of whiskey was adminis- 
tered to dogs I, 2, and 3. 

At 12.33.30, dog I, blood-pressure, 1 10 mm. ; stroke, 113 mm. ; 
pulse, 124; respiration, 48. 

Dog 2, blood-pressure, 90 mm. ; stroke, 4 mm. ; 
pulse, 122; respiration, 48. 

Dog 3, blood-pressure, 98 mm.; stroke, 12 mm.; 
pulse, 128; respiration, 48. 
At 12.45, dog i> blood-pressure, 130 mm.; stroke, 18 mm.; 
pulse, 120; respiration, 28. 

Dog 2, blood-pressure, 75 mm. ; stroke, 10 mm. ; 
pulse, 116; respiration, 52. 

Dog 3, blood-pressure, 105 mm.; stroke, 10 mm.; 
pulse, 116; respiration, 56. 
At 12.46, 22 minims of whiskey were injected in dogs i, 2, 
and 3. 

Dog I, blood-pressure, 105 mm.; stroke, 12 mm. 
Dog 2, blood-pressure, 70 mm. ; stroke, 10 mm. 
Dog 3, blood-pressure, 100 mm.; stroke, 11 mm. 

At 12.53, electrical stimulation was applied to the sciatics, very 
slight reaction resulting. 

At 1. 24, dog I, blood-pressure, 88 mm.; pulse, 120; respira- 
tion, 36. 

Dog 2, blood-pressure, 56 mm.; pulse, 120; respira- 
tion, 52. 

Dog 3, blood-pressure, 105 mm.; pulse, 124; respira- 
tion, 60. 



26 ON THE BLOOD-PRESSURE IN SURGERY. 



At 1.25, 22 minims of whiskey were injected in dogs i, 2, 
and 3. 

Dog I, blood-pressure, 128 mm.; pulse, 120; respira- 
tion, 53. 

Dog 3, blood-pressure, 105 mm.; pulse, 124; respira- 
tion, 60. 

An injection of 22 minims of whiskey was adminis- 
tered to dogs I, 2, and 3. 

Dog I, blood-pressure, 88 mm.; pulse, 120; respira- 
tion, 136. 

Dog 2, blood-pressure, 55 mm.; pulse, 116; respira- 
tion, 64. 

Dog 3, blood-pressure, 102 mm.; pulse, 108; res- 
piration, 52. 

At 1. 48, dog I, blood-pressure, 95 mm.; stroke, 9 mm.; 
pulse, 100; respiration, 36. 

Dog 2, blood-pressure, 60 mm. ; stroke, 80 mm. ; 
pulse, 116; respiration, 172. 

Dog 3, blood-pressure, no mm.; stroke, 10 mm.; 
pulse, 108; respiration, 63. 
At 1.49, 1.5 drams of whiskey were injected in dogs i, 2, and 3. 

There was a gradual fall in the blood-pressure of 
each animal. 

Dog I, blood-pressure, 80 mm.; stroke, 11 mm.; 
pulse, 92 ; respiration, 36. 

Dog 2, blood-pressure, 54 mm.; stroke, 10 mm.; 
pulse, 80; respiration, 72. 

Dog 3, blood-pressure, 105 mm.; stroke, 10 mm.; 
pulse, 96 ; respiration, 64. 

At 1.53, stimulation of the sciatic, in each animal, was fol- 
lowed by a slight reaction. 

At 1.57.30, dog I, blood-pressure, 92 mm.; stroke, 8 mm.; 
pulse, 114; respiration, 40. 

Dog 2, blood-pressure, 55 mm. ; stroke, 9 mm. ; 
pulse, 72 ; respiration, 68. 

Dog 3, blood-pressure, 105 mm.; stroke, 10 mm.; 
pulse, 88; respiration, 68. 



ON THE BLOOD-PRESSURE IN SURGERY. 



27 



At 1. 59, an injection of 1.5 drams of whiskey was given to 
dogs I, 2, and 3. 

At 2.00, a gradual fall in the blood-pressure was recorded, fol- 
lowed by a rise. 

Dog I, blood-pressure, 90 mm.; stroke, 19 mm.; 
pulse, 80; respiration, 36. 

Dog 2, blood-pressure, 54 mm. ; stroke, 10 mm. ; 
pulse, 72 ; respiration, 72. 

Dog 3, blood-pressure, 105 mm.; stroke, 18 mm.; 
pulse, 92; respiration, 72. 
At 2.08.45, dog I, blood-pressure, 88 mm.; stroke, 12 mm.; 
pulse, 84; respiration, 36. 

Dog 2, blood-pressure, 60 mm.; stroke, 10 mm.; 
pulse, 100; respiration, 72. 

Dog 3, blood-pressure, 95 mm. ; stroke, 9 mm. ; 
pulse, 100; respiration, 68. 
At 2.09.30, 1.5 drams of whiskey were injected in dogs i, 2, 
and 3. Immediately following the injection there 
occurred a vasomotor break-down. 
Dog I, the blood-pressure fell to the abscissa line. 
Dog 2, blood-pressure, 62 mm. ; stroke, 8 mm. ; 
pulse, 100; respiration, 72. 

Dog 3, blood-pressure, 95 mm.; stroke, 11 mm.; 
pulse, 96; respiration, 72. 
At 2. 13. 1 5, electrical stimulation of the sciatics in dogs 2 and 
3 was followed by a very slight reaction in the blood- 
pressure. 

At 2.15, dog 2, blood-pressure, 68 mm.; stroke, 10 mm.; 
pulse, 104; respiration, 72. 

Dog 3, blood-pressure, 95 mm. ; stroke, 10 mm. ; 

pulse, 104; respiration, 72. 
At 2. 16, 1.5 drams of whiskey were injected in dogs 2 and 3. 
At 2.22, dog 2, blood-pressure, 66 mm.; stroke, 8 mm.; 

pulse, 88; respiration, 72. 

Dog 3, blood-pressure, 93 mm.; stroke, 10 mm.; 
pulse, 88; respiration, 68. 
At 2.24, dogs 2 and 3 were killed by allowing MgS04 solutior 
to flow into the carotid cannula. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 9. 
Alcohol. 

Dog; weight, fifteen kilos. Morphin and ether anes- 
thesia. The animal was reduced to surgical anes- 
thesia by the usual method. 

Blood-pressure recorded 146 mm. After the blood- 
pressure had reached 60 mm. artificial respiration 
was supplied. One-half dram of brandy was injected 
into the jugular vein. A slight rise, followed by a 
fall, a little below the previous level, occurred. 
Twenty minutes later, i dram of brandy was given 
An immediate fall followed. 

After twenty minutes 2 drams of brandy were ad- 
ministered. A marked fall in the blood-pressure oc- 
curred. 

Five minutes later i ounce of brandy was given. 
A fall in the blood-pressure was recorded. The ani- 
mal was then killed by bleeding. 

Experiment 10. 
Alcohol. 

Dog ; in good physical condition ; weight, fourteen 
kilos. Morphin and ether anesthesia. 
Initial blood-pressure recorded 138 mm. The animal 
was reduced to surgical shock. Blood-pressure, 42 
mm. ; respirations, irregular and shallow. 
One-half dram of brandy was injected into the jugu- 
lar vein. No immediate effect was noted. One dram 
was injected. A considerable decline in the blood- 
pressure was recorded ; the respirations were un- 
changed. After twenty minutes the blood-pressure 
increased to 52 mm. 

The injection of i dram of brandy into the jugular 
vein was followed by an irregular blood-pressure and 
a considerable fall. A repetition of the injection was 



ON THE BLOOD-PRESSURE IN SURGERY. 



followed by a very marked fall. After ten minutes 
the blood-pressure rose to the previous level. The 
animal was then used for other experiments. 

Experiment 11. 
Alcohol. 

Mongrel dog ; weight, ten kilos. Morphin and ether 
anesthesia. 

Initial blood-pressure, 124 mm. The blood-pressure 
was lowered by exposure and manipulation of the 
nerve-trunks of the extremities. The animal was 
reduced as low as possible before brandy was given. 
Blood-pressure, 24 mm. ; respiration, short and shal- 
low. One minim of brandy was injected into the 
jugular vein. No effect was noted. Two minims 
produced no effect; 4 minims, no effect; 8 minims, 
but slight effect; 16 minims produced no effect; 32 
minims, an increased length in the stroke of the 
manometer, with a slight decline of the blood-pressure 
and shallow respiration. One dram increased the 
fall in the blood-pressure; 2 drams produced a very 
marked fall, and the animal died. 

Experiment 12. 
Alcohol. 

Dog; weight, twenty kilos. Morphin and ether an- 
esthesia. 

Blood-pressure, 139 mm. The animal took the anes- 
thetic very badly. Artificial respiration was necessary 
from the beginning of the experiment. 
Shock was produced by splanchnic and somatic dis- 
section. The animal was reduced to profound shock 
before any treatment was given. Blood-pressure 
registered 20 mm. ; respiration had ceased several 
times; artificial respiration was maintained. An 



ON THE BLOOD-PRESSURE IN SURGERY. 



injection of Yz dram of brandy was made into the 
jugular vein without effect. Two drams produced 
a marked fall in the blood-pressure. Artificial respi- 
ration was necessary. 

In five minutes 2 more drams were given. The 
blood-pressure suffered a marked decline. Death 
soon followed. 

Experiment 13. 
Alcohol. 

Bull dog ; good condition ; weight, thirteen kilos. 
Morphin and ether anesthesia. 

The animal was reduced to shock as in the preceding 
experiment; blood-pressure, 80 mm. 
After I dram of alcohol was injected in the jugular 
vein there was a temporary rise followed by consider- 
able fall ; respiration became shallow. One dram was 
then given, producing a marked fall in the blood- 
pressure; respirations were unchanged. 
Further dissection reduced the animal to 48 mm. 
blood-pressure. One dram of brandy produced a 
slight fall ; 2 drams produced a marked fall in the 
blood-pressure. One-half ounce was then given, and 
the animal was killed. 

Experiment 14. 
Alcohol. 

Small dog; weight, seven kilos. Morphin and ether 
anesthesia. 

Preliminary blood-pressure, 126 mm. The animal 
was reduced to surgical shock by splanchnic and so- 
matic dissection and exposure. 

When the blood-pressure registered 52 mm. alcohol 
was injected into the jugular vein. A slight irregu- 
larity in the pulse occurred with a very marked ir- 
regularity in the respiration. The injection of ^ 



ON THE BLOOD-PRESSURE IN SURGERY. 31 

ounce of brandy was followed by a staggering fall 
in the blood-pressure, with immediate cessation of 
respiration. 

Experiment 15. 
Alcohol. 

Small dog; weight, six kilos. Ether and morphin 
anesthesia. 

The animal was reduced to surgical shock. Blood- 
pressure, 36 mm. Ten minims of brandy were in- 
jected into the jugular vein. No change in the respi- 
ration or in the blood-pressure was noted. One-half 
dram of brandy was followed by a fall in the blood- 
pressure. Two drams of brandy were followed by a 
decline in the blood-pressure, the strokes becoming a 
little longer ; the respirations were unchanged. Two 
drams of brandy were followed by a wavering in 
the blood-pressure, and later by a greater fall. Four 
drams of brandy produced a very, marked fall in the 
blood-pressure; respirations were greatly slowed. 
Eight drams of brandy produced almost instantane- 
ous death. 

Experiment 16. 
Nitroglycerin and Amyl Nitrite. 

Bull-dog. Ether anesthesia. The abdomen was 
opened and the intestines were manipulated, pro- 
ducing shock. 

At 5.30, blood-pressure, 90 mm.; pulse, 176; respiration, 40. 

At 5.34, blood-pressure, 60 mm.; pulse, 210; respiration, 66. 

At 5.35, there was injected into the femoral vein 2.5 minims 
of a one per cent, solution of nitroglycerin. A slight 
rise was followed by a slight fall. Pressure then rose 
again to 60 mm. 

At 5.37, blood-pressure, 60 mm.; pulse, 210; respiration, 66. 

An injection of 2.5 minims of a one per cent, solu- 
tion of nitroglycerin was made. A slight rise, fol- 



I 

32 ON THE BLOOD-PRESSURE IN SURGERY. 

lowed by a marked fall, in the blood-pressure was 
noted. The stroke was slightly lengthened. 

At 5.39, there was injected 10 minims of a one per cent, solu- 
tion of nitroglycerin. 

At 5.39.30, blood-pressure, 60 mm. ; pulse, 176 ; respiration, 80. 

At 5.40, blood-pressure, 50 mm.; pulse, 172; respiration, 64. 

At 5.42, blood-pressure, 50 mm.; pulse, 132; respiration, 68. 

At 5.45, blood-pressure, 50 mm.; pulse, 180; respiration, 36. 

At 5.46, there was injected 10 minims of a one per cent, solu- 
tion of nitroglycerin. The pulse was very irregular 
and the blood-pressure fell to 45 mm. temporarily. 

At 5.47, blood-pressure, 50 mm.; pulse, 180; respiration, 28. 

At 5.50, blood-pressure, 40 mm.; pulse, 200; respiration, 24 
and irregular. 

At 5.52, there was injected 25 minims of a one per cent, solu- 
tion of nitroglycerin. 

At 5.54, blood-pressure, 40 mm.; pulse, 180; respiration, 24. 
The animal was killed. 

Experiment 17. 
Nitroglycerin. 

Small mongrel pup; weight, three kilos. Morphin 

and ether anesthesia. 
At 12.05, blood-pressure, 120 mm.; pulse, 210; respiration, 60. 
At 12.06.30, an intravenous injection of 10 minims of a one 

per cent, solution of nitroglycerin was made. 
At 12.07, blood-pressure, 60 mm.; pulse, 192; respiration, 48. 
At 12.10, blood-pressure, 1 10 mm. ; pulse, 210; respiration, 48. 
At 12.15, blood-pressure, 100 mm. ; pulse, 180; respiration, 36. 

The animal was then killed. 

Experiment 18. 
Nitroglycerin; Abdominal Aorta clamped. 

Dog; weight, ten kilos. The abdominal aorta was 
clamped. The strokes became long; respiration al- 
most ceased ; artificial respiration was supplied. 



ON THE BLOOD-PRESSURE IN SURGERY. 



33 



Three minutes later the blood-pressure strokes be- 
came shortened. The blood-pressure rose to the 



s - 



1^ ^ 



« o 



3 = 

3 „ 
•3 W 




former level. The respiratory wave upon the blood- 
pressure curve was marked. The aorta in this case 
3 



ON THE BLOOD-PRESSURE IN SURGERY. 



was clamped above the splanchnic vessels. One- 
fourth grain of nitroglycerin was injected. A marked 
fall in the blood-pressure followed. 
Two minutes later ^ grain was administered. The 
blood-pressure showed an additional fall. 
One-half minute later ^ grain was given. The 
blood-pressure fell, but rapidly recovered in one-half 
minute. 

Three-fourths of a minute later ^ grain of nitro- 
glycerin was given. A marked fall, followed by a 
recovery, was noted. 

One minute later ^ grain of nitroglycerin was ad- 
ministered ; a fall in the blood-pressure, followed by 
a recovery, was noted. The respirations were un- 
changed. 

One minute later ^ grain was given, and was fol- 
lowed by a fall in the blood-pressure, recovery soon 
occurring. 

Two minutes later ^ grain of nitroglycerin was 
given. A marked fall in the blood-pressure followed. 
One-quarter of a minute later the blood-pressure be- 
gan to recover, at which time 3^ grain of nitro- 
glycerin was given. A deep fall in the blood- 
pressure, followed by recovery, was noted. A few 
drops of chloroform in the trachea caused sudden 
death. 

Experiment 19. 
Nitroglycerin and Amyl Nitrite. 

Dog; fair physical condition. Ether anesthesia. 
The blood-pressure cannula was applied in the ca- 
rotid. 

The control blood-pressure recorded 124 mm. The 
animal was reduced to surgical shock by cutting away 
the thorax and manipulating the heart and lungs. 
This was attended by very marked fluctuations of the 
blood-pressure and an irregularity in the respiration. 



ON THE BLOOD-PRESSURE IN SURGERY. 



The thorax was then closed air-tight. The blood- 
pressure had fallen to 70 mm. A few drops of amyl 
nitrite were placed upon the inhaling cone. A fall 
in the blood-pressure followed, two seconds later; 
after ten seconds had elapsed a pronounced fall was 
recorded. The pressure remained low for ten min- 
utes, after which three drops of amyl nitrite were 
placed upon the inhaling cone. Within five seconds 
there was a fall of 5 mm. in the blood-pressure. 
The low level was maintained for ten seconds, after 
which there occurred a gradual rise. 
Five minutes later 5 minims of amyl nitrite were 
dropped on the cone, and at the expiration of ten 
seconds the blood-pressure began to fall, the strokes 
of the writing style being long and fluctuating. The 
respiration became shallow and the blood-pressure 
recovered with marked respiratory changes. The 
dog-board was inverted, head up ; the blood-pressure 
fell. On turning the dog-board in the opposite direc- 
tion, the blood-pressure reached the former level. 
The dog was then inverted, head down, and the 
blood-pressure rose. When the animal was in the 
horizontal position the blood-pressure fell to the pre- 
vious level, and the excursions of the writing style 
became longer and more irregular. Respiration be- 
came so infrequent and shallow that artificial respi- 
ration was supplied. Three minims of amyl nitrite 
were administered. There was a marked fall in the 
blood-pressure, followed by a rise. Ten minims of 
amyl nitrite were given. A marked fall followed, 
the strokes became long, the blood dark, respiration 
failed, and the animal died in one minute. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 20. 
Nitroglycerin. 

Mongrel dog ; physical condition good ; weight, eight 
kilos. Ether anesthesia. 

The blood-pressure cannula was adjusted in the ca- 
rotid. The initial blood-pressure was 139 mm. The 
animal was reduced to surgical shock by a double 
amputation at the hip- joints and long continued ma- 
nipulation of the sciatic nerve, attended with some 
loss of blood. Blood-pressure, 38 mm. 
An injection of Voo grain of nitroglycerin was made 
into the left jugular vein. An immediate fall in the 
blood-pressure, with rapid compensation, followed. 
A second dose of Voo grain of nitroglycerin was fol- 
lowed by a marked fall with a compensatory rise. 
The third dose was administered at the expiration 
of three minutes. A fall and like compensation was 
recorded. An injection of V20 grain was then given 
into the jugular vein. A slight fall in the blood- 
pressure followed, after which compensation oc- 
curred. 

After two minutes had elapsed ^/oq grain was given. 
No effect was noted. The blood-pressure rose slightly 
after five minutes. 

Two minutes later j4, grain of nitroglycerin was 
administered, after which there was a marked fall 
in the blood-pressure, followed by a convulsion. The 
blood-pressure recovered itself, and % grain of 
nitroglycerin was given with no immediate effect. 
After one minute there was recorded a slight rise. 
Respiration failed at this point. One-fourth grain of 
nitroglycerin was administered. The blood-pressure 
fell sharply, followed by a rather slow recovery. 
One-twentieth grain was injected into the jugular 
vein. The blood-pressure fell, and artificial respira- 
tion was necessary. Tracings of the blood-pressure 



ON THE BLOOD-PRESSURE IN SURGERY. 



showed a very marked efifect of the inspiratory and 
expiratory phases of respiration. The dog was in- 
verted head down, and the blood-pressure rose 
quickly. In the horizontal position the blood-press- 
ure fell slightly from the previous level ; then the 
gradual rise occurred. The administration of 1200 
c.c. of saline solution was followed by a decided rise. 
Respirations were increased and the excursions be- 
came longer. The injection of grain of nitro- 
glycerin was followed by a slight fall, after which 
compensation occurred. Two minutes later convul- 
sions developed. The blood-pressure tracing showed 
intermittent strokes. The blood-pressure gradually 
fell until death. 

Experiment 21. 
Nitroglycerin. 

Mongrel dog; weight, eight kilos. Ether anesthesia. 
Blood-pressure cannula in the carotid. The animal 
was reduced to surgical shock by manipulation of 
the splanchnic area and excision of the stomach. 
There was administered Viso grain of nitroglycerin 
into the left jugular vein. The injection was at- 
tended by a slight fall, compensation occurring after 
ten seconds. 

At the expiration of five minutes ^/go grain of nitro- 
glycerin was injected into the jugular vein. A 
marked fall in the blood-pressure immediately fol- 
lowed, after which the pressure rose higher than the 
previous level. 

After fifteen minutes the blood-pressure was 32 mm. 
After the respirations began to fail and the blood- 
pressure to fall an injection of Ve* grain of nitro- 
glycerin was given. A very slight fall was noted. 
After ten minutes the pressure began to decline, arti- 
ficial respiration becoming necessary, the animal was 



ON THE BLOOD-PRESSURE IN SURGERY. 



given Vi5 grain of nitroglycerin, which was attended 
by a marked fall, after which compensation took place 
at the end of two minutes. A gradual fall was again 
inaugurated. No further injections were made and 
the animal died after ten minutes. 

Experiment 22. 
Nitroglycerin. 

Black mongrel dog; weight, eight kilos. 
The blood-pressure cannula was adjusted in the ca- 
rotid. Owing to excessive ether anesthesia, artificial 
respirations were necessary. During this time the ma- 
nometer exhibited long strokes. After respirations be- 
came normal, and the blood-pressure tracing became 
even at 142 mm., the animal was reduced to surgical 
shock by extensive exposure and bloodless operation 
upon the intestines and the stomach. Several times 
it was necessary to maintain artificial respiration after 
the dog's blood-pressure had reached 36 mm. An 
injection of ^/i2o grain of nitroglycerin was followed 
by a fall in the blood-pressure, with a prompt recov- 
ery six seconds later ; the respirations became slower. 
Two minutes later there was administered ^ / 20 grain 
of nitroglycerin. A fall in the blood-pressure, with 
a quick recovery, was recorded. 

Two minutes later V20 grain was given; the blood- 
pressure fell and a prompt recovery followed. 
One minute later the injection of ^/j grain of nitro- 
glycerin was followed by a fall in the blood-pressure 
more marked than the preceding. A prompt recovery 
followed. 

There was administered one minute and a half later 
^/^ grain of nitroglycerin. The blood-pressure fell, 
followed by recovery. 

In one minute and a half another dose of grain 
of nitroglycerin was administered. A very slight fall 



ON THE BLOOD-PRESSURE IN SURGERY. ^9 

in the blood-pressure with an immediate recovery 
followed. 

One minute later the injection of ^/^ grain of nitro- 
glycerin was followed by a slight fall and a prompt 
recovery. A repetition of the foregoing was fol- 
lowed by a slight fall in the blood-pressure. Strokes 
became longer, the respiration short and shallow. 
Two minutes after the last injection a convulsion ap- 
peared. During the convulsion the blood-pressure 
rose and fell with a muscular spasm. The blood- 
pressure fell to the abscissa line and the animal died. 

Experiment 23. 
Nitroglycerin, 

Dog ; spaniel ; weight, nine kilos ; young and in good 
physical condition. Ether anesthesia. 
The control blood-pressure recorded 138 mm. The 
animal was reduced to surgical shock by exposing the 
skull, uncovering the brain extensively, and ma- 
nipulating the dura mater. During this exposure the 
blood-pressure and the respirations were extremely 
irregular. The respirations became embarrassed, the 
blood-pressure fell, and the animal was in profound 
shock. An injection of ^/iso grain of nitroglycerin 
into the jugular vein was followed by a slight fall 
in the blood-pressure, which immediately recovered 
itself. 

Three minutes later, Viso grain of nitroglycerin was 
injected into the jugular vein. A fall with immedi- 
ate compensation was noted. The blood-pressure 
began to decline after five minutes. The injection 
of nitroglycerin into the jugular vein was followed 
by an immediate fall and with compensation. The 
respirations were improved. 

Two minutes later the blood-pressure again began to 
decline. One-fiftieth grain of nitroglycerin was in- 



ON THE BLOOD-PRESSURE IN SURGERY. 



jected into the jugular vein. A considerable fall, fol- 
lowed by a rise to the level recorded before the in- 
jection, was noted. 

After four minutes the blood-pressure began to de- 
cline. 

One-thirtieth grain of nitroglycerin was injected 
into the jugular vein. There was immediately a 
marked fall, after which compensation occurred. The 
heart-beats were slower, the respiration more shallow, 
and the blood rather dark. The animal was failing. 
The injection of }i grain of nitroglycerin was fol- 
lowed by a fall in the blood-pressure with partial 
compensation. Five minutes later the animal died. 

Experiment 24. 
Nitroglycerin. 

Fox terrier ; weight, seven kilos ; good physical con- 
dition. Ether anesthesia. 

Blood-pressure cannula in the carotid. The animal 
was reduced to surgical shock by extensive dissection 
in the somatic area and the exposure and manipula- 
tion of the stomach and intestines. No therapeutic 
test was made until the respirations were much em- 
barrassed, and the blood-pressure was reduced from 
the normal (140 mm. ) to 22 mm. One one-hundred- 
and-eightieth grain of nitroglycerin was injected into 
the jugular vein. An immediate fall followed, after 
which compensation took place. The respiration re- 
mained unchanged and the heart's action was reduced 
in frequency. The blood-pressure soon began to 
further decline, and ^Ao grain of nitroglycerin was 
injected into the jugular vein. Again there was a 
slight fall, after which there was a rise to a point 
somewhat higher than before the injection. The 
strokes became longer, the blood dark, and the respi- 
ration more embarrassed. Artificial respiration was 



ON THE BLOOD-PRESSURE IN SURGERY. 



maintained. The blood-pressure began to decline and 
V64 grain of nitroglycerin was given. A marked 
fall followed by partial compensation was noted. 
The respiration became more embarrassed and the 
animal died after twelve minutes. 

Experiment 25. 
Nitroglycerin. 

Mongrel dog ; weight, ten kilos ; fair condition. 
Ether anesthesia. 

Blood-pressure cannula in the right carotid. The 
dog was reduced to surgical shock by somatic dis- 
section and exposure and manipulation of splanchnic 
area. One one-hundred-and-eightieth grain of nitro- 
glycerin was injected into the jugular vein with no 
efifect. 

Five minutes later ^Ao grain was given. This was 

followed by a slight fall in the pressure, and later a 

rise higher than the former level. 

After ten minutes grain of nitroglycerin was 

given. There was an immediate and a considerable 

fall. Twelve seconds later the former level had been 

regained. 

In five minutes grain of nitroglycerin was in- 
jected into the jugular vein without effect. 
Two minutes later grain was administered. A 
sharp and decided fall in the blood-pressure followed 
and later convulsions developed. The blood became 
dark, respiration ceased, and the animal died. 

Experiment 26. 
Amyl Nitrite. 

Bull-dog. Ether anesthesia. 

Blood-pressure cannula in the carotid. The animal 
was reduced to surgical shock by excessive manipula- 
tion of the testicle and the abdominal viscera. The 



1 



ON THE BLOOD-PRESSURE IN SURGERY. 



control blood-pressure was 128 mm. After the 
blood-pressure had fallen to 38 mm. 2 minims of 
amyl nitrite were dropped upon the inhaler. A 
slight fall in the blood-pressure followed; the res- 
piration became deeper. In ten seconds the blood- 
pressure began to rise, regaining its former level. 
Five minutes later 3 minims of amyl nitrite were 
dropped on the inhaler. An immediate fall in the 
blood-pressure followed. The heart-strokes became 
long and fluctuating. The effects of respiration 
on the blood-pressure curve were marked. The 
respirations were shallow and the blood was dark. 
The blood-pressure began to decline. Five minims of 
amyl nitrite were dropped on the inhaler. A marked 
fall in the blood-pressure occurred, with extremely 
long and irregular heart-strokes. The respiration be- 
came more shallow, and the blood extremely dark. 
Artificial respiration was supplied. No further thera- 
peutic measures were attempted. The dog lived 
twenty minutes, the blood-pressure gradually falling. 
The dog died of respiratory failure. 

Experiment 21. 

Amyl Nitrite. Asphyxia. 

Mongrel dog ; weight, eleven kilos ; good condition. 
Ether anesthesia. 

The respiratory cannula was adjusted in the trachea 
and the blood-pressure cannula in the carotid. The 
trachea was then clamped. The respiratory excur- 
sion on the blood-pressure tracing became long and 
irregular, and the rate markedly decreased. After 
an increase in the blood-pressure and the respiration, 
there was a decline in both, and later, total cessation. 
Fifteen seconds after the heart had stopped artificial 
respiration was supplied and the dog was inverted, 
head up, then head down. A sharp and immediate 



ON THE BLOOD-PRESSURE IN SURGERY. 43 

rise in the blood-pressure followed. When the blood- 
pressure was approaching- the normal, nitrite of amyl 
was given by inhalation. A sudden fall in the blood- 
pressure almost to the abscissa followed. 

Experiment 28. 
Amyl Nitrite. Asphyxia. 

Old mongrel bull dog; good condition; weight, thir- 
teen kilos. Ether anesthesia. 

The respiratory cannula was adjusted in the trachea, 
the blood-pressure cannula in the carotid. After a 
control had been taken a few drops of amyl nitrite 
were placed on the inhaler. Within two seconds there 
occurred a fall in the blood-pressure. Ten seconds 
later the fall was pronounced. The pressure re- 
mained low, and after a second dose a further fall 
occurred, persisting five seconds. The pressure grad- 
ually fell during the following ten seconds. It re- 
mained low for ten seconds, and then began a gradual 
rise. The third inhalation of 5 minims was fol- 
lowed by an immediate fall, the style exhibiting long 
and variable strokes. The respiratory curve on the 
blood-pressure was very marked. Respiration be- 
came shallow and the blood-pressure slowly recov- 
ered. When the dog was inverted head up, the blood- 
pressure rose slowly ; when horizontal, it fell to the 
previous level ; when inverted head down, the blood- 
pressure rose. On assuming a horizontal position 
the pressure rose gradually and remained fairly con- 
stant; the long and irregular excursion became still 
longer and more irregular. On inverting the dog, 
head down, a slight rise promptly followed. On re- 
suming a horizontal position, the blood-pressure 
again fell. Pressure upon the splanchnic area pro- 
duced an immediate rise, which fell again on removal 
of the pressure. The trachea was then clamped. A 



ON THE BLOOD-PRESSURE IN SURGERY. 



rise occurred, which was followed later by a fall in 
the blood-pressure, after which the pressure continued 
to gradually fall until death. 

Experiment 29. 
Digitalis. 

Mongrel dog; weight, eight and one-half kilos; good 
condition. Ether anesthesia. 
At 10.40, the initial blood-pressure was 140 mm.; pulse, 180; 
stroke, 11. 

At 10.45, 1-3 ^-C- of tincture of digitalis were injected into the 

femoral vein. 
At 10.46, pulse, 160; stroke, 12 mm. 

At 1 0.48, the foregoing injection was repeated. The blood- 
pressure remained unchanged. The length of the 
stroke increased 2 mm. ; pulse, 170. 

At 10.51, 1.3 c.c. of tincture of digitalis were injected. 

At 10.54, 1.3 c.c. of tincture of digitalis were injected. 

At 10.56, blood-pressure, 155 mm.; stroke, 20; pulse, 160. 
The animal was killed. 

Experiment 30. 
Digitalis. 

Mongrel dog; weight, eleven kilos. Morphine and 
ether anesthesia. 

The spinal cord was severed in lower dorsal region. 
At 4. 10, blood-pressure, 60 mm.; pulse, 210. 
At 4. 1 1, an injection of 20 minims of tincture of digitalis was 

administeredr 

At 4. 14, blood-pressure, 85 mm.; pulse, 180; respiration, 72. 
At 4. 1 7, blood-pressure, 100 mm.; pulse, 160; respiration, 148. 
Fig. 5 shows the steady rise in the blood-pressure. 

Experiment 31. 
Digitalis. 

Spaniel; weight, twenty-one pounds; good physical 
condition. Ether anesthesia. 



ON THE BLOOD-PRESSURE IN SURGERY. 45 





cq U 



ON THE BLOOD-PRESSURE IN SURGERY. 



The respiratory cannula was adjusted in the trachea, 
the blood-pressure cannula in the carotid. Control 
blood-pressure, 146 mm. The larynx and trachea 
were exposed. The larynx was opened and the 
mucosa manipulated. A temporary cessation of 
respiration and a decided fall in the blood-pressure 
occurred. Several repetitions were followed by a 
considerable loss of pressure. Other dissections were 
made in the somatic area, reducing the blood-pressure 
to 80 mm. Ten minims of tincture of digitalis in- 
jected into the jugular vein was followed by a slight 
temporary fall in the blood-pressure, after which 
there was a gradual rise. The blood-pressure rose 
higher than before the injection. 
Five minutes later 10 minims were injected into the 
jugular vein. There was a slight rise in the blood- 
pressure, followed by a fall and a gradual rise. The 
animal was then subjected to extensive manipu- 
lation of the splanchnic area. The blood-pressure 
fell to 26 mm., and respiration became irregular. 
An injection of five minims of tincture of digitalis 
into the jugular vein was followed by a slight fall 
in the blood-pressure, and later a gradual rise, a little 
higher than before the injection. Respiration became 
more shallow and the blood-pressure began to fall. 
Fifteen minims of tincture of digitalis injected into 
the jugular veins prodvtced no effect. Five minutes 
later the blood-pressure fell. 

The injection of 20 minims of digitalis into the jugu- 
lar vein was followed by no change in the blood- 
pressure; respiration then failed, and the animal 
died. 

Experiment 32. 
Digitalis. 

Dog ; weight, seven kilos ; fair condition. Ether an- 
esthesia. 

Control blood-pressure, 132 mm. The animal was 



ON THE BLOOD-PRESSURE IN SURGERY. 



reduced to surgical shock by manipulating the 
splanchnic area. Two minims of tincture of digitalis 
were injected into the jugular vein. No effect was 
noted. 

Three minutes later, an injection of 4 minims of tinc- 
ture of digitalis was given into the jugular vein. 
A slight fall, followed by a temporary rise, was 
noted. 

Ten minutes later, eight minims of digitalis were 
injected, followed by a temporary cessation in the 
decline of the blood-pressure. Respirations became 
more full ; the blood-pressure again declined. Thirty 
minims of tincture of digitalis were injected without 
effect. The animal died in a few minutes. 

Experiment 33. * 
Digitalis. 

Dog; weight, five and one-half kilos; good physical 
condition. Ether anesthesia. 

The blood-pressure cannula was adjusted in the ca- 
rotid. Initial blood-pressure, 122 mm. The animal 
was reduced to surgical shock by dissection and ma- 
nipulation of the somatic and splanchnic areas. 
Five minims of tincture of digitalis were injected into 
the jugular vein without effect. Blood-pressure, 
32 mm. 

The intestines were exposed, and during the next ten 
minutes the blood-pressure dropped to 26 mm. 
Ten minims of digitalis were injected into the jugu- 
lar vein. No effect was noted. 

Three minutes later 20 minims were injected. The 
animal died. 

Experiment 34. 
Digitalis. 

Male mongrel dog; weight, ten kilos; good condi- 
tion. Ether anesthesia. 



ON THE BLOOD-PRESSURE IN SURGERY. 

Blood-pressure cannula in the carotid. The animal 

was reduced to surgical shock as in the preceding 

experiment. Blood-pressure, 24 mm. 

Ten minims of tincture of digitalis were injected into 

the jugular vein. No effect was noted. 

Five minutes later 30 minims of tincture of digitalis 

were injected, without effect. Blood-pressure, 18 mm. 

Respiration failed. The animal died. 

Experiment 35. 
Digitalis. 

Dog; weight, ten kilos. Ether anesthesia. 
Initial blood-pressure, 168 mm. The animal was re- 
duced to surgical shock by the removal of one-fourth 
of the integument, and by exposure and manipulation 
of the stomach and of the intestines. The spinal 
cord was severed in the lower dorsal region. 
At the expiration of fifty-five minutes the respirations 
became shallow and the heart action quickened. The 
carotid artery exhibited a pulse of small volume. The 
blood-pressure at this time registered 80 mm. ; respi- 
ration, shallow but regular. 

Ten minims of tincture of digitalis were injected into 
the jugular vein. After a lapse of seven seconds there 
was a rise in the blood-pressure ; the curve was rapid 
in its ascent. In three or four seconds the blood- 
pressure began to decline, after which a steady rise 
was inaugurated, extending through a period of 
twenty minutes, the blood-pressure finally recording 
120 mm. At the time the digitalis was administered 
the manometer strokes were extremely short, being 
less than 2 mm. in length. 

At the end of this time the manometer excursions 
were four times as long as at the time of the injection. 
The respiration assumed a Cheyne-Stokes character. 
There was a slight fall, followed by a rise in blood- 
4 



ON THE BLOOD-PRESSURE IN SURGERY. 

pressure. The heart again beat strongly, and on pal- 
pation the carotid pulse was hard. Its ascent was 
gradual, as was also the descent. 
Three hundred and fifty c.c. of normal saline solution 
were given. There was an immediate rise in the 
blood-pressure, followed by a marked fall. The 
heart-strokes became long and less frequent. This 
irregularity was followed by a steady rise in the 
blood-pressure until it reached 140 mm. The strokes 
were long, the pulse full, the heart-beats strong. 
Respiration during this time continued to be of the 
Cheyne-Stokes type. 

The animal was observed for one hour and thirty 
minutes, at which time the pulse-rate had somewhat 
fallen. The pressure was reduced from 140 mm. to 
120 mm. The animal was then killed. 

Experiment 36. 
Digitalis. 

Mdngrel dog; weight, seven kilos; poor condition. 
Ether anesthesia. 

The animal was reduced to surgical shock by ex- 
posing and manipulating the abdominal viscera, to- 
gether with strong irritation of the sciatic nerve and 
extensive dissection of the skin of the body. 
At the expiration of fifty minutes the blood-pressure 
was 70 mm., having fallen from 150 mm. Respira- 
tion was very shallow and frequent. 
Ten minims of tincture of digitalis were injected into 
the jugular vein. The respiration became more rapid ; 
later, more shallow. The blood-pressure steadily rose 
to 120 mm., and was well sustained, with a fair and 
even curve. The animal was killed twenty minutes 
later. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 37. 
Digitalis. 

Small terrier ; weight, four and one-half kilos. Mor- 
phin and ether anesthesia. 
At 10.38, blood-pressure, 160 mm.; pulse, 198; respiration, 
108. 

At 10.43, shock was produced by exposing and manipulating 
the intestines and crushing the feet. Blood-pressure 
fell to 100 mm. ; later, to 45 mm. ; respiration ceased 
and artificial respiration was maintained. The blood- 
pressure rose very slightly. 

At 10.55, 20 minims of tincture of digitalis were injected intra- 
venously. The blood-pressure showed a slight tem- 
porary fall, followed by a slow but steady rise until 
100 mm. was reached. 

At 1 1. 00, blood-pressure, 100 mm.; pulse, 160; respiration, 
imperceptible. An injection of 25 minims of whiskey 
was administered ; cardiac paralysis followed ; blood- 
pressure fell to 5 mm. The animal died. 

Experiment 38. 
Digitalis. 

Female spaniel ; weight, six kilos. 
At 1 1. 1 5, ether anesthesia was given. The tracheal and carotid 

cannulae were applied. 
At 1 1.35, normal blood-pressure, 130 mm.; stroke, 8 mm.; 

pulse, 160; respiration, 80. 
At 1 1.46, the femoral vein was exposed. 
At 12. 04, the sciatic nerves were exposed. 
At 12.06, the intestines were exposed. 

At 1 2. 1 2, the control blood-pressure was 85 mm.; stroke, 9 

mm.; pulse, 140; respiration, 112. 
At 12.12.30, the sciatic was stimulated; blood-pressure, 93 

mm. ; stroke, 9 mm. 
At 12.16, blood-pressure, 74 mm.; stroke, 8 mm.; pulse, 36; 

respiration, 76. 



ON THE BLOOD-PRESSURE IN SURGERY. ^3 

At 12.16.30, an injection of 10 minims of tincture of digitalis 
was given. 

At 12.18, blood-pressure, 85 mm.; stroke, 9 mm.; pulse, 116; 

respiration, 80. The rise was slow and sustained. 
At 12.20, the sciatic was stimulated; blood-pressure, no mm. ; 

stroke, 10 mm. 

At 12.35, blood-pressure, mm.; stroke, 8 mm.; pulse, 132; 
respiration, 76. 

At 12.35.30, an injection of 10 minims of tincture of digitalis 
was given. A slow and sustained rise in the blood- 
pressure occurred ; stroke, 8 mm. ; pulse, 148; respi- 
ration 76. 

At 12.44, the sciatic nerve was stimulated. There was an 
abrupt rise in the blood-pressure to 1 18 mm. 

At 12.54, blood-pressure, 94 mm.; stroke, 8 mm.; pulse, 132; 
respiration, 64. 

At 12.54.30, an injection of 10 minims of tincture of digitalis 
was given. A slight rise occurred, which was sus- 
tained. Blood-pressure, 98 mm.; stroke, 10 mm.; 
pulse, 136; respiration, 72. 

At I.I 1.30, the hind foot was burned. The blood-pressure rose 
sharply to 118 mm. A slow fall followed. 

At 1. 14.30, blood-pressure, 76 mm. ; stroke, 8 mm. ; pulse, 128; 
respiration, 60. 

At 1. 15, an injection of 10 minims of tincture of digitalis was 
given. Blood-pressure, 94 mm. ; stroke, 8 mm. ; 
pulse, 128; respiration, 144. 

At 1. 20, the sciatic was stimulated. A sharp rise of 17 mm. 
followed. 

At 1.30, blood-pressure, 82 mm.; stroke, 8 mm; pulse, 140; 
respiration, 72. 

At 1.36, an injection of 10 minims of tincture of digitalis was 
given. Blood-pressure, 92 mm. ; stroke, 9 mm. ; 
pulse, 144; respiration, 68. 

At 1.42, the foot was burned. A sharp rise in the blood-press- 
ure followed. 

At 1.57, blood-pressure, 97; stroke, 2 mm.; pulse, 152; respi- 
ration, 78. 



I 



54 ON THE BLOOD-PRESSURE IN SURGERY. 

At 1.58, an injection of 10 minims of tincture of digitalis was 
given. Blood-pressure, 109 mm. ; stroke, 2 mm. ; 
pulse, 132; respiration, 76. 

At 2.32, blood-pressure, 95 mm.; stroke, 5 mm.; pulse, 144; 
respiration, 64. 

At 2.33, an injection of 10 minims of tincture of digitalis was 
given. Blood-pressure, 99 mm. ; stroke, 6 mm. ; 
pulse, 160; respiration, 58. 

At 3.15, blood-pressure, 80 mm.; stroke, 2 mm.; pulse, 148; 
respiration, 44. 

At 3. 16, an injection of 10 minims of tincture of digitalis was 
given. Blood-pressure, 88 mm. ; stroke, 3 mm. ; 
pulse, 144; respiration, 136. The pulse was irregular 
and arrhythmic; the diastole was frequently much 
prolonged. 

At 4.09, the dog died of sudden cardiac failure. 

Experiments 39, 40. 
Digitalis. 

Dog I, male bird-dog; good condition; weight, 
eleven kilos. 

Dog 2, male bird-dog; good condition; weight, 
ten kilos. Ether anesthesia ; tracheal and carotid can- 
nulae were adjusted. 
At 9.35, preliminary observations were as follows: 

Dog I, blood-pressure, 150 mm.; stroke, 16 mm.; 
pulse, 208; respiration, 68. 

Dog 2, blood-pressure, 140 mm.; stroke 10 mm.; 
. pulse, 188; respiration, 76. The animals were re- 
duced to shock. 

At 10.00, shock, dog I, blood-pressure, 115 mm.; stroke, 16 

mm.; pulse, 148; respiration, 32. 

Dog 2, blood-pressure, 95 mm. ; stroke, 5 mm. ; 

pulse, 156; respiration, 80. 
At 10.10, dog I, the sciatic was stimulated. A sharp fall and 

then a gradual rise, returning to a former level, were 

recorded. 



ON THE BLOOD-PRESSURE IN SURGERY. ^5 

Dog 2, a slow fall, then a gradual rise, lo mm. above 
the former level, were observed. 
Atio.2i,dog I, blood-pressure, 130 mm.; stroke, 18 mm.; 
pulse, 140; respiration, 148. 

Dog 2, blood-pressure, no mm.; stroke, 5 mm.; 
pulse, 140; respiration, 80. 
At 10.31.30, dog 2, an injection of 10 minims of tincture of 
digitalis was given. 

Dog I, an injection of 10 minims of tincture of digi- 
talis was given. 
At 10.32.15, dog 2, the heart-rate became slow and a slight in- 
crease of blood-pressure with irregular action was 
noted. 

Dog I, the heart-rate lessened. There was a slight 
rise in the blood-pressure, lasting a brief period. For 
one and one-half minutes after the injection the heart- 
rate in both animals became accelerated. 
Dog I, blood-pressure, 135 mm.; stroke, 18 mm.; 
pulse, 172; respiration, 48. 

Dog 2, blood-pressure, 115 mm. ; stroke, 4 mm. ; 

pulse, 168; respiration, 80. 
At 10.37, the sciatics were electrically stimulated. In both 

dogs a slight rise was noted, followed by a fall of 10 

millimetres, with a prompt return to the former level. 
At 1 1. 00, dog I, blood-pressure, 115 mm.; stroke, 3 mm.; 

pulse, 152; respiration, 48. 

Dog 2, blood-pressure, 115 mm. ; stroke, 8 ; pulse, 
148; respiration, 76. 
At 1 1.55, dog I, blood-pressure, no mm.; stroke, 4 mm.; 
pulse, 56; respiration, 44. 

Dog 2, blood-pressure, 114 mm.; stroke, 10 mm.; 
pulse, 152; respiration, 80. 
At 12.10, the pulse and respiration were constant in each dog. 

Dog I, an injection of 5 minims of tincture of digi- 
talis was given. 

Dog 2, an injection of 5 minims of tincture of digi- 
talis was given. Immediately following the injection 
the blood-pressure in each animal rose. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Before the injection : 

Dog I, blood-pressure, 105 mm.; stroke, 4 mm.; 
pulse, 56; respiration, 49. 

Dog 2, blood-pressure, 116 mm.; stroke, 8 mm.; 
pulse, 1 52 ; respiration, 76. 
After the injection : 

Dog I , blood-pressure, 1 08 mm ; stroke, 4 mm. ; 
pulse, 144; respiration, 40. 

Dog 2, blood-pressure, 125 mm.; stroke, 8 mm.; 

pulse, 136; respiration, 72. 
At 12.15, "iog" I' the sciatic was stimulated. 
At 12.15.30, dog 2, the sciatic was stimulated. A sharp fall 

with a gradual rise to the previous level occurred. 
At 1.44, dog I, blood-pressure, 107 mm. ; stroke, 8 mm. ; pulse, 

160; respiration, 44. 

Dog 2, blood-pressure, 115 mm.; stroke, 8 mm.; 
pulse, 172; respiration, 80. 
At 1.44.30, dog I, an injection of 10 minims of digitalis was 
given. 

Dog 2, an injection of 10 minims of digitalis was 
given. 

At 1.46, a gradual rise was recorded. 

At 1.47, dog I, blood-pressure, 112 mm. ; stroke, 4 mm. ; pulse, 
64; respiration, 40. 

Dog 2, blood-pressure, 120 mm.; stroke, 8 mm.; 

pulse, 164; respiration, 76. 
At 1.48.30, dog I, the sciatic was stimulated. 

Dog 2, the sciatic was stimulated. 

Dog I showed a sharp rise with a correspondingly 

sharp fall, then a gradual recovery to the former level. 

Dog 2 showed a sharp rise with a correspondingly 

sharp fall and a gradual return to the former level. 
At 2.20, dog I, an injection of 10 minims of tincture of digitalis 

was given. 

Dog 2, an injection of 10 minims of tincture of digi- 
talis was given. The results were the same as in the 
previous injection. 



ON THE BLOOD-PRESSURE IN SURGERY. 57 
Before the injection: 

Dog I , blood-pressure, 1 20 mm. ; stroke, 4 mm. 
Dog 2, blood-pressure, 118 mm. ; stroke, 20 mm. 
After the injection : 

Dog I, blood-pressure, 122 mm.; stroke, 4 mm. 

Dog 2, blood-pressure, 112 mm.; stroke, 20 mm. 
At 2.30, stimulation of the sciatics produced a similar effect. 

For ten minutes there was a slight increase in the 

blood-pressure. 
At 2.40, dog I, blood-pressure, 150 mm. ; stroke, 4 mm. 

Dog 2, blood-pressure, 135 mm.; stroke, 20 mm. 

After the foregoing the strokes were markedly in- 
creased. 

Dog I, blood-pressure, 80 mm. 
Dog 2, blood-pressure, 60 mm. 
At 2.44, both dogs died of cardiac failure. 

Experiments 41, 42. 

Digitalis and Saline. 

Dog I, male mongrel; poor condition; weight, six 
kilos. 

Dog 2, female mongrel ; fair condition ; weight, five 

kilos. Ether anesthesia. 
At 9.45, the tracheal and carotid cannulse were adjusted. 
At 10.27, preliminary observations were as follows : ■ 

Dog I, blood-pressure, 134 mm.; stroke, 6 mm.; 

pulse, 164; respiration, 68. 

Dog 2, blood-pressure, 125 mm.; stroke, 6 mm.; 
pulse, 168; respiration, 52. 

The animals were reduced to shock by exposing and 
manipulating the intestines. The femoral vein and 
sciatic nerve of each dog were exposed. 
At 10.28, dog I, blood-pressure, 94 mm.; stroke, 2 mm.; 
pulse, 152; respiration, 48. 

Dog 2, blood-pressure, 75 mm. ; stroke, 6 mm. ; 
pulse, 128; respiration, 65. 



58 



ON THE BLOOD-PRESSURE IN SURGERY. 



At 10.30.30, the sciatic nerves were stimulated, with results as 
follows : 



1 *s 



o S 
12 9- 



5 S 



i 0. t 



Dog I, an abrupt rise in the blood-pressure of 2 mm., 
followed by a slow decline. 



ON THE BLOOD-PRESSURE IN SURGERY. 59 

Dog 2, slow rise in the blood-pressure of 2.5 mm. 
At 10.31.30, dog 2, 5 minims of tincture of digitalis were in- 
jected. 

At 10.32, dog I, an equal amovmt of normal saline was injected. 

Dog I, blood-pressure, 100 mm.; stroke, 4 mm.; 
pulse, 160; respiration, 52. 

Dog 2, blood-pressure, 98 mm. ; stroke, 5 mm. ; pulse, 
120; respiration, 64. 
At 10.35, the sciatics were stimulated. 

Dog I, a rise in the blood-pressure of 8 mm. was 
noted. 

Dog 2, a rise in the blood-pressure of 5 mm. was 

noted. The rise was more abrupt in dog i. 
At 10.47, ^og" I) 20 minims of normal saline were injected. 

Dog 2, 5 minims of tincture of digitalis were injected. 

In both animals a gradual rise followed. 

Dog I, the blood-pressure rose 8 mm. 

Dog 2, the blood-pressure rose 22 mm. 
At 10.51, the sciatics were stimulated. 

Dog I, the blood-pressure rose 6 mm. 

Dog 2, the blood-pressure rose 5 mm. 
At 10.55, dog 2, 5 minims of tincture of digitalis were injected. 

Dog I, 20 minims of saline were injected. 

Dog I, the blood-pressure rose 5 mm. 

Dog 2, the blood-pressure rose 5 mm. 
At 1 1.3 1, the sciatics were stimulated. 

Dog I, a rise in the blood-pressure of 4 mm. followed. 

Dog 2, a rise in the blood-pressure of 13 mm. fol- 
lowed. 

At 1 1.55, dog 2, 10 minims of tincture of digitalis were in- 
jected. 

Dog I, 20 minims of saline were injected. 
At 1 1.55.30, dog I, blood-pressure, 96 mm.; stroke, 10 mm.; 
pulse, 156; respiration, 52. 

Dog 2, blood-pressure, 92 mm. ; stroke, 4 mm. ; 
pulse, 52; respiration, 144. 
At 11.59, dog i> the sciatic was stimulated. 



6o ON THE BLOOD-PRESSURE IN SURGERY. 



At 11.59.30, dog 2, the sciatic was stimulated. 

At 12.02, dog I, a rise in the blood-pressure of 8 mm. followed. 

Dog 2, a rise in the blood-pressure of 5 mm. fol- 
lowed. 

Dog I, repeated clots occurred. 

At 1. 10, dog I died of an excessive dose of MgS04. 

At 1.53.30, dog 2, 10 minims of tincture of digitalis were in- 
jected. Blood-pressure, 96 mm.; stroke, 4 mm.; 
pulse, 144; respiration, 36. 

At 1.55, dog 2, the sciatics were stimulated. An abrupt rise in 
the blood-pressure of 17 mm. occurred. 

At 3.00, dog 2, 10 minims of tincture of digitalis were injected. 

Blood-pressure, 94 mm.; stroke, 4 mm.; pulse, 144; 
respiration, 40. 

At 3.03, the sciatics were stimulated. A rise in the blood- 
pressure of 9 mm. followed. 

At 3.03.30, the sciatics were electrically stimulated. A rise in 
the blood-pressure of 14 mm. followed. 

At 4.39, dog 2, 10 minims of tincture of digitalis were injected. 

Blood-pressure, 70 mm.; stroke, 6 mm.; pulse, 104; 
respiration, 20. 

At 4.44, the sciatics were stimulated. A rise in the blood- 
pressure of 2 mm. occurred. 
At 5.00, dog 2 died of respiratory failure. 

Experiment 43. 
Simultaneous Drug Experiments. 

Seven small dogs that had been in confinement for 
a considerable time, and were in poor physical con- 
dition, were subjected to simultaneous experiment. 
The animals were of almost equal weight, and were 
anesthetized with morphin and ether. They were 
reduced to surgical shock in a manner as nearly alike 
as possible. The intestines were removed; the in- 
tegument was removed from one side of the trunk, 
and the raw surfaces were sponged. The animals 



ON THE BLOOD-PRESSURE IN SURGERY. 6l 



were reduced to a degree of shock as nearly equal as 
could be determined. 

Dog I was given 20 minims of tincture of digitalis, 
in small doses, at intervals until his death. 
Dog 2 was treated in like manner. 
Dog 3 was used as a control. 

Dog 4 was given strychnin, in small doses, at inter- 
vals. 

Dog 5 was given whiskey, in 25-minim doses, at half- 
hour intervals. 

Dog 6 was treated the same as dog 5. 
Dog 7 was given repeated doses of strychnin, but con- 
vulsions developed unexpectedly early. 
The sequence of their death was : 
Strychnin, thirty-three minutes. 
Digitalis, three hours and thirty-one minutes. 
Strychnin, three hours and fifty-two minutes. 
Whiskey, four hours and sixteen minutes. 
Digitalis, four hours and twelve minutes. 
Control, four hours and fifty-seven minutes. 
Whiskey, five hours and ten minutes. 
At the conclusion of the experiment it was apparent 
that simultaneous experiments were not well adapted 
to the work, and no more were made. 

Experiment 44. 
Strychnin. 

Mongrel dog; weight, fourteen kilos; good condi- 
tion. Ether anesthesia. 

Respiratory cannula was adjusted in the trachea, the 
blood-pressure in the carotid. The dog was reduced 
to considerable shock by opening the abdomen and 
roughly manipulating the intestines while exposing 
them to the air. It required fifteen minutes to reduce 
the blood-pressure from 140 mm. (the normal) to 
96 mm. At this time the respiration became shallow. 



J 



ON THE BLOOD-PRESSURE IN SURGERY. 



and the pause increased in length. An injection of 
Vioo grain of strychnin was made into the jugular 
vein. 

Following this there was a rise in the blood-pressure 
of 2 mm. ; the blood-pressure curve was rather ir- 
regular, but continued a trifle higher than previous 
to the injection. 

Twenty minutes later the intestines were again ex- 
posed and roughly manipulated until the animal was 
in a very low state, the blood-pressure being 30 mm. 
At this time artificial respiration was occasionally 
necessary. 

On administering Voo grain of strychnin there fol- 
lowed a slight rise, the strokes becoming a little 
shorter; after which the blood-pressure fell to the 
previous level. 

Fifteen minutes later, another injection of V120 grain 
of strychnin was given, followed in five minutes by 
slight muscular twitchings. The blood-pressure rose 
gradually, and convulsions developed. During the 
convulsions the blood-pressure rose considerably. 
Following this the blood-pressure fell to a point lower 
than it was before the administration of the strychnin. 
The animal soon died. 

Experiment 45. 
Strychnin. 

Old bull-dog; weight, twelve kilos. Ether anes- 
thesia. 

Respiratory cannula in the trachea; blood-pressure 
cannula in the carotid. After a control had been 
taken, in which the blood-pressure was 146 mm., the 
animal was subjected to manipulation, operation on 
the skin, including extensive removal, irritation of the 
sciatic nerve and the nerves of the tracheal plexus, 
and finally opening of the abdomen and exposure and 



ON THE BLOOD-PRESSURE IN SURGERY. 



manipulation of the intestines during the period of 
one hour, at which time there was imminent danger 
of death from shock. The intestines were then re- 
placed, the skin everywhere sutured, after which the 
blood-pressure recorded 26 mm., it having been as 
low as 20 mm. 

One two-hundredth of a grain of strychnin was then 
injected into the jugular vein. A rise in the blood- 
pressure with a rather irregular curve followed, the 
rise at no time being more than 3 mm. 
A second injection of ■'/240 grain was given fifteen 
minutes later, with no effect. 

Ten minutes later the third injection was given, with- 
out efifect. 

Five minutes later a fourth injection was given. A 
slight twitching of the muscles and an irregular rise 
in the blood-pressure, synchronous with the presence 
of the twitching, appeared. 

Five minutes later the fifth injection was given. This 
was followed by an additional twitching and a slight 
convvilsion, during which the blood-pressure curve ex- 
hibited a very irregular line, the regularity being syn- 
chronous with the contraction of the muscles. After 
the convulsions the blood-pressv;re fell again. A few- 
minutes later the animal died. 

Experiment 46. 
Strychnin. 

Mongrel dog ; weight, nine kilos ; good condition. 
Ether anesthesia. 

Respiratory cannula was adjusted in the trachea, the 
blood-pressure cannula in the right carotid. An ex- 
cessive amount of ether was given at the beginning 
of an experiment. A rapid fall in the blood-pressure 
resulted. Artificial respiration became necessary. 
Extensive operations were then performed on the 



ON THE BLOOD-PRESSURE IN SURGERY. 



extremities, such as crushing the paws, breaking- the 
legs, and manipulating the nerve-trunks. This was 
followed by a rise in the blood-pressure, and later a 
fall. Extensive cutting of the integument was fol- 
lowed by a fall in the blood-pressure from 134 
mm. to 50 mm. The wounds were then closed, and 
after fifteen minutes had elapsed the blood-pressure 
rose to 58 mm. At this time there was some hemor- 
rhage. Blood-pressure recorded at 48 mm. 
An injection of V120 grain of strychnin was given 
into the jugular vein, without effect. 
In ten minutes the blood-pressure began a steady de- 
cline, and respiration began to fail. 
A second injection of ■^/i2o grain of strychnin was 
given, but no effect was observed. 
In five minutes the third injection was given. The 
blood-pressure continued to fall and respiration 
failed progressively. 

The administration of Voo grain of strychnin was 
followed by a convulsion within two minutes. A 
temporary rise in the blood-pressure was noted. Ir- 
regularity in the pressure occurred synchronously 
with the convulsion, after which the blood-pressure 
rapidly fell and the animal died. 

Experiment 47. 
Strychnin. 

Mongrel dog ; weight, nine kilos ; good physical con- 
dition. Ether anesthesia. 

Respiratory cannula was adjusted in the trachea, 
blood-pressure cannula in the carotid. The animal 
was reduced to surgical shock by manipulating and 
exposing the intestines, and abstracting eight ounces 
of blood. The initial blood-pressure was 132 mm. 
The wounds were closed, and after the blood-pressure 
had fallen to 28 mm. V240 grain of strychnin was 



ON THE BLOOD-PRESSURE IN SURGERY. 65 



given. A slight fall was recorded, followed by a cor- 
responding rise in the blood-pressure. This rise was 
but momentary, after which the blood-pressure fell 
to 34 mm. 

In five minutes the second injection was given ; a 
slight fall in the blood-pressure, followed by a tem- 
porary rise, not so high as the previous one, occurred. 
The blood-pressure now began to decline. The ani- 
mal was breathing irregularly and the blood was 
becoming dark. 

The administration of V20 grain of strychnin was 
almost immediately followed by muscular twitching 
and spasms. During the spasm respiration failed, 
after which respiratory excursions became deeper and 
more regular. There was a slight fall in the blood- 
pressure immediately after the injection. During the 
convulsion there was a rise. The curve showing 
great regularity. The blood-pressure then fell gradu- 
ally and the muscles became relaxed. Respiration 
failed and the animal died. 

Experiment 48. 
Strychnin. 

Mongrel dog; weight, six kilos; general condition 
fair. Ether anesthesia. 

Respiratory cannula in the trachea, blood-pressure 
cannula in the carotid. The extensive dissection of 
the skin and the abdomen, with some loss of blood, 
together with manipulation and exposure of intes- 
tines, soon reduced the blood-pressure from the con- 
trol of 121 mm. to 32 mm. At this time respiration 
was failing, and artificial respiration was maintained. 
The administration of V120 grain into the jugular 
vein was followed by a gradual progressive rise in 
the blood-pressure. The blood-pressure soon began 
to fall, the decline being gradual. 

5 



ON THE BLOOD-PRESSURE IN SURGERY. 



The injection of V120 grain of strychnin ten minutes 
later produced no appreciable effect. Blood-pressure 
then recorded 18 mm. 

A second and third injection of V120 grain was fol- 
lowed by no change in the blood-pressure. The ani- 
mal died. 

Experiment 49. 
Strychnin. 

Dog ; weight, six kilos ; greatly emaciated ; had a 
purulent ophthalmia and rhinitis. The anesthesia 
was badly borne, artificial respiration being necessary 
on several occasions before the experiment began. 
The control blood-pressure was 68 mm. Incising the 
■skin was attended with but little hemorrhage, as 
great anemia was present. The blood-pressure soon 
began to fall, and when it registered 38 mm., ^/z^o 
grain of strychnin was given, without effect. Arti- 
ficial respiration now became necessary, and the 
blood-pressure began to decline. 

An injection of V120 grain of strychnin was attended 
by twitching, and a temporary rise in the blood- 
pressure occurred synchronously with muscular con- 
tractions. After the twitching had ceased the blood- 
pressure fell to a point below the level recorded 
before injection. The blood-pressure began to de- 
cline rapidly. 

An injection of ^/i2o grain was followed by a slight 
convulsion. As the muscles became relaxed the 
blood-pressure fell rapidly and the dog died in a few 
minutes. 

Experiment 50. 
Strychnin. 

Dog; weight, ten kilos, good physical condition. 
Ether anesthesia. 

Respiratory cannula in the trachea, blood-pressure 
cannula in the carotid. The animal was reduced to 



ON THE BLOOD-PRESSURE IN SURGERY. 



surgical shock by skin dissection, irritation of the 
nerve-trunks, and exposure and manipulation of the 
jntestines. Respiration was extremely irregular dur- 
ing the manipulation. The intestines were replaced 
and the wounds closed. The blood-pressure gradually 
fell and respiration became shallow and slow. Blood- 
pressure fell to 32 mm. and artificial respiration was 
given for a few minutes. 

The injection of V240 grain of strychnin into the 
jugular vein was attended by a slight temporary fall, 
after which a rise occurred. Respiration became a 
little fuller, and more rapid. 

Ten minutes later four ounces of blood were taken 
from the jugular vein; the blood-pressure fell 5 mm. 
during the following five minutes. Respiration failed 
rapidly and the blood-pressure declined. 
Injections of ^/i2o grain of strychnin at intervals of 
Two minutes were given. No effect was noted until 
the fourth injection, when a marked muscular twitch- 
ing occurred, with a rise in the blood-pressure; after 
relaxation of the muscle the pressure gradually fell 
to the abscissa line, and respiration failed. The ani- 
mal died. 

Experiment 51. 
Strychnin. 

Dog; weight, ten kilos, good physical condition. 
Ether anesthesia. 

Respiratory cannula in the trachea, blood-pressure 
cannula in the carotid. Control blood-pressure. 
138 mm. 

Tearing, crushing the brachial plexus, sciatic nerve, 
abstracting six ounces of blood, and performing pylo- 
rectomy reduced the dog to profound shock. Respi- 
ration was irregular. The blood-pressure fell to 36 
mm. The injection of V120 grain of strychnin was 
given into the jugular vein. No change was noted 



ON THE BLOOD-PRESSURE IN SURGERY. 



in respiration or in the blood-pressure. Later the 
blood-pressure began to fall, but artificial respiration 
was not required. No further change was noted. 
Two minutes later a second injection of V240 grain 
of strychnin into the jugular vein was given; arti- 
ficial respiration became necessary. A slight rise in 
the blood-pressure followed. 

After a lapse of six minutes there was a fall, at which 
time a third injection of ■^/24o grain of strychnin was 
given into the jugular vein. This was followed by 
a gradual rise of 2 mm. in the blood-pressure. The 
pressure became steady and continued so for fifteen 
minutes without much change, after which a slight 
decline was inaugurated. 

A fourth injection of like amount was then given. 
A rise in the blood-pressure followed. In eight min- 
utes a decline began. 

A fifth injection of V240 grain of strychnin was fol- 
lowed by a slight twitching and a slight rise in the 
blood-pressure ; a moderate convulsion followed. 
After the convulsion the blood-pressure declined 
rapidly. Respiration was improved. 
An injection of V240 grain of strychnin was given, 
followed by a marked convulsion, after which blood- 
pressure declined to 24 mm. 

An injection of ^/go grain of strychnin was now given 
into the jugular vein. Convulsion followed, during 
which the blood-pressure fluctuated greatly, and with 
muscular relaxation it fell. The animal died in a 
few minutes. 

Experiment 52. 
Strychnin. 

Young dog; weight, five kilos; excellent physical 
condition. Ether anesthesia. 

Blood-pressure cannula in the carotid, respiratory 
cannula in the trachea; some difficulty was encoun- 



ON THE BLOOD-PRESSURE IN SURGERY. 69 

tered in inserting the cannula into the carotid. The 
animal was reduced to shock as in the foregoing ex- 
periment, including the abstracting of four ounces of 
blood. 

Blood-pressure fell so rapidly and respiration became 
so shallow that normal salt solution was given tem- 
porarily, to save the animal. There was some rise 
in the blood-pressure, with increased length of stroke, 
following the administration of 353 c.c. of the salt 
solution. A hypodermic of strychnin was given with 
the salt solution. At first ^/^q grain was injected 
without effect. Another injection of ^/go grain was 
without effect. A third injection was followed by 
longer and more rapid respiration. The blood- 
pressure began to fall, and more salt solution was 
given. The length of the stroke increased, but the 
blood-pressure remained unchanged. A hypoder- 
mic of Vso grain of strychnin was given. A con- 
vulsion followed, after which the animal died. 



Experiment 53. 
Strychnin. 

Dog, water-spaniel ; weight, six kilos ; young and 
in good physical condition. Ether anesthesia; con- 
siderable difficulty was encountered in obtaining an 
even anesthesia. 

Control blood-pressure, 124 mm. Resection of about 
one-half of the small intestines, with some loss of 
blood, together with excision of the spleen, reduced 
the animal to deep shock. After the blood-pressure 
had reached 32 mm. the respiration became very 
irregular. Normal saline solution was given. Fol- 
lowing this there was a rise of 9 mm. in the blood- 
pressure. H?emostasis was completed and the abdo- 
men closed. 

The blood-pressure had, in the mean time, fallen to 



ON THE BLOOD-PRESSURE IN SURGERY. 



24 mm. The administration of Veo grain of strych- 
nin was attended by a very marked rise in the blood- 
pressure. After eight minutes a dechne began. The 
rapidity of the heart was increased and the length of 
the strokes diminished. The decline then became 
gradual. Salt solution was again given; strokes in- 
creased, temporarily raising the blood-pressure. 
A second injection of -^/sq grain of strychnin was 
given. A less marked effect than the first was noted. 
A third injection followed. The blood-pressure was 
slowly falling. After a lapse of twenty minutes, 
slight twitching of the muscles was noted. Again 
there was a slight rise in the blood-pressure. In 
twenty minutes the blood-pressvire fell and the animal 
died. 

Experiment 54. 
Strychnin. 

Dog. Ether anesthesia. The animal was reduced to 
shock by exposing and manipulating the intestines. 

At 12.26, blood-pressure, 105 mm.; pulse, 168; respiration, 32. 

At 12.28, ^/cjo grain of strychnin was injected. Blood-pressure, 
80 mm.; pulse, 148; respiration, 36. 

At 12.29, blood-pressure, 100 mm. ; pulse, 128; respiration, 32. 

At 12.30, the left hind foot was burned. 

At 12.31, blood-pressure, 100 mm. ; pulse, 128; respiration, 32. 
At 12.34, blood-pressure, iiomm. ; pulse, 136; respiration, 40. 
At 12.35, blood-pressure, 120 mm.; pulse, 140; respiration, 40. 

The rise in pressure was gradual and well sustained. 

Experiment 55. 
Strychnin. 

Mongrel dog; weight, 14 kilos; good condition. 

Morphine and ether anesthesia. 
At 1.35, blood-pressure, 140 mm.; pulse, 148; respiration, 24. 
At 1.40, blood-pressure, 140 mm.; pulse, 144; respiration, 36. 



ON THE BLOOD-PRESSURE IN SURGERY. 



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72 ON THE BLOOD-PRESSURE IN SURGERY. 

At 1.42, V20 grain of strychnin was injected. 

After an immediate fall in blood-pressure convulsions 
appeared, during which the blood-pressure rapidly- 
rose higher than normal. A few minutes after cessa- 
tion of the convulsion peripheral irritation caused a 
second convulsion, attended by a marked rise in the 
blood-pressure with great irregularities. 




Fig. 9. — Exp. 55. — Note the marked rise in the blood-pressure following the injection of 
Tj'j grain of strychnin. The long excursions were caused by the convulsions. After the animal 
became quiet peripheral stimulation caused a second convulsion. 

At 1.47, Voo grain of strychnin was given. 
At 1.50, blood-pressure, 140 mm.; pulse, 144; respiration, 124. 
At 1. 51, V30 grain of strychnin was injected. 
At 1.55, blood-pressure, 140 mm.; pulse, 180; respiration, 36. 
At 2.00, blood-pressure, 140 mm.; pulse, 200; respiration, 36. 
At2.oi, Vir> grain of strychnin was injected; convulsions ap- 
peared. 

At 2.06, blood-pressure, 146 mm.; pulse, 144; respiration, 48. 

Experiment 56. 

Strychnin. Asphyxia. 

Mongrel dog ; good condition ; weight, six kilos. 
Ether anesthesia. 

Blood-presure cannula was adjusted in the carotid. 



ON THE BLOOD-PRESSURE IN SURGERY. 73 

Asphyxia was induced by damping the trachea. A 
marked rise in the blood-pressure, with an increased 
respiratory action, followed. Later, the blood-press- 
ure fell. 

Upon the administration of 500 c.c. of saline infusion 
the pressure rose to almost the previous level. 
The trachea was again clamped, following which the 
previous phenomena were observed. Asphyxia was 
continued until the heart stopped. At the expiration 
of sixteen seconds without a heart-beat, grain of 
strychnin in saline infusion was injected. The ani- 
mal was inverted, head up then head down; after 
which the heart resumed its beat, the blood-pressure 
rising almost to its previous level. The animal was 
then killed. 

At autopsy the veins were found to be engorged and 
the intestines cyanotic. 

Experiments 57, 58. 

Strychnin. Control. 

Dog I, female; fair condition; weight, five kilos. 
Dog 2, male ; good condition ; weight, five kilos. 

At 10.30, ether anesthesia was administered. 

At 11.02.30, the normal blood-pressure was as follows : 

Dog I, blood-pressure, 148 mm.; stroke, 14 mm. 
Dog 2, blood-pressure, 82 mm. ; stroke, 10 mm. 

At 1 1. 10, the intestines of both dogs were exposed and ma- 
nipulated. 

At 1 1.24, dog I, blood-pressure, 102 mm.; stroke, 14 mm. 

Dog 2, blood-pressure, 75 mm. ; stroke, 14 mm. 
At 11.48, dog I, blood-pressure, 126 mm. ; stroke, 14 mm. 

Dog 2, blood-pressure, 78 mm.; stroke, 16 mm. 
At 11.48.30, dog 2, ^/go grain of strychnin in 25 minims saline 

was injected. 

Dog I, the same amount of saline was injected. 
At 1 1.54, dog I, blood-pressure, 112 mm.; stroke, 14 mm. 

Dog 2, blood-pressure, 70 mm.; stroke, 18 mm. 



74 ON THE BLOOD-PRESSURE IN SURGERY. 

At 11.57, dog I' blood-pressure, no mm.; stroke, 12 mm. 

Dog 2, blood-pressure, 78 mm.; stroke, 16 mm. 
At 12.02.30, dog I, blood-pressure, no mm.; stroke, 14 mm.; 

clot in the cannula. 

Dog 2, blood-pressure, 70 mm. ; stroke, 16 mm. 
At 12.17, dog I' blood-pressure, 105 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 68 mm.; stroke, 16 mm. 
At 12.20.30, dog I, blood-pressure, 102 mm.; stroke, 14 mm.; 

pulse, 144. 

Dog 2, blood-pressure, 68 mm. ; stroke, 19 mm. ; 
pulse, 92. 

At 12.21, dog 2, ^/go grain of strychnin in 25 minims saline was 
injected. 

Dog I, an equal amount of saline was administered. 
At 12.41.30, dog I, blood-pressure, 90 mm.; stroke, 16 mm.; 
pulse, 112. 

Dog 2, blood-pressure, 60 mm.; stroke, 18; pulse, 
96. 

At 12.52.30, dog I, blood-pressure, 95 mm.; stroke, 12 mm.; 
pulse, 108. 

Dog 2, blood-pressure, 70 mm.; stroke, 16 mm.; 
pulse, 88. 

At 1. 10, dog I, blood-pressure, 100 mm.; stroke, 10 mm.; 
pulse, 116. 

Dog 2, blood-pressure, 68 mm. ; stroke, 14 mm. ; 
pulse, 84. 

At 1. 1 8, dog I, blood-pressure, 100 mm.; stroke, 10 mm.; 
pulse, 144. 

Dog 2, blood-pressure, 68 mm. ; stroke, 14 mm. ; 
pulse, 102. 

At 1. 19, dog 2, V90 grain of strychnin in 25 minims saline was 
injected. 

Dog I, the same amount of saline was injected. 
At 1. 20, dog I, blood-pressure, 100 mm.; stroke, 10 mm.; 
pulse, 142 ; a clot in the cannula. 
Dog 2, blood-pressure, 65 mm. ; stroke, 14 mm. ; 
pulse, 104. 



ON THE BLOOD-PRESSURE IN SURGERY. 75 

At 1. 37, dog I, blood-pressure, 98 mm.; stroke, 3 mm.; pulse, 
116. 

Dog 2, blood-pressure, 65 mm.; stroke, 15 mm.; 
pulse, 96. 

At 2.00, dog I, blood-pressure, 78 mm.; stroke, 18 mm. 

Dog 2, blood-pressure, 62 mm. ; stroke, 14 mm. ; 
pulse, 95. 

At 3. 10, dog I, dead, clot and MgS04 (accident). 

Dog 2, blood-pressure, 60 mm.; stroke, 10 mm. 
At 4. 1 7, dog 2, blood-pressure, 54 mm. ; stroke, 10 mm. 
At 4. 18, dog 2, an injection of Vso grain of strychnin was given. 
At 4.20, dog 2, blood-pressure, 55 mm.; stroke, 10 mm. 
At 4.27, dog 2, blood-pressure, 60 mm. ; stroke, 12 mm. 

From 4.34 to 4.40 the heart was regular. The dog 

died of respiratory failure. Blood-pressure, 46 mm. ; 

stroke, 10 mm. 

Remarks. — Artificial respiration was maintained forty-five 
minutes in dog i. There were irregularities and a 
gradual fall in the blood-pressure. The reflexes were 
heightened during this experiment. 

Experiment 69. 
Strychnin. 

Old dog ; weight, twelve kilos. Ether anesthesia. 
Initial blood-pressure, 166 mm.; stroke, 10 mm.; 
respiration somewhat irregular. The skin was re- 
moved from a portion of the trunk and the raw sur- 
faces sponged. The blood-pressure was reduced to 
130 mm. 

One-sixtieth grain of strychnin sulphate in solution 
of 22 minims of water was given at three-minute in- 
tervals. Following the injection the respiration 
became more regular. The length of the stroke was 
reduced to 2 mm. The respiratory alterations upon 
the blood-pressure curve were not marked. 
After the second injection the blood-pressure fell to 



i 



76 



ON THE BLOOD-PRESSURE IN SURGERY. 



125 mm. The length of the stroke increased to 
4 mm. 

The third injection caused the blood-pressure to rise 
abruptly to 160 mm., and convulsions appeared. 
After ten minutes a decline began and continued until 
the pressure reached 55 mm. Respiration became 
spasmodic. The decline renewed and continued until 
the blood-pressure recorded 26 mm. The animal soon 
died. 

Experiment 60. 
Strychnin. 

Fox terrier ; fair condition ; weight, six kilos. Ether 
anesthesia. 

Preliminary blood-pressure, 130 mm.; stroke, 12 
mm. The animal was reduced to slight shock. One 
one-hundred-and-twentieth grain of strychnin was 
given intravenously. The blood-pressure rose 2 mm., 
followed by a fall of 8 mm. The length of stroke fell 
from 12 to 10 mm. 

Eight minutes later a second injection of V120 grain 
of strychnin was given. The blood-pressure con- 
tinued to fall, losing 32 mm. 

Four minutes later the blood-pressure rose 38 mm., 
the pulse became more rapid, and respiration slower. 
After five minutes the blood-pressure lost 10 mm. 
One minute later another injection of ^/i2o grain of 
strychnin was given. Blood-pressure fell 24 mm. In 
five minutes it regained 12 mm. 
Another injection of ^/i2o grain of strychnin was 
administered. The blood-pressure fell to 95 mm. 
Five minutes later another injection of ^/i2o grain of 
strychnin was given. No change in the blood- 
pressure followed. After ten minutes the blood- 
pressure fell 12 points. The reflexes were greatly 
heightened. Slight convulsions appeared on light 
irritation. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Three minutes later an injection of Vi2o grain 
of strychnin was followed by convulsions. The 
blood-pressure at this time recorded 68 mm. It rose 
rapidly to 152 mm., after which a gradual decline oc- 
curred. After twenty-three minutes the blood-press- 
ure fell to 106 mm. 

One one-hundred-and-twentieth grain of strychnin 
was again administered. Convulsions followed. The 
blood-pressure gradually fell to 30 mm. The ani- 
mal died three hours after the first injection. 

Experiment 61. 
Strychnin. 

Bull terrier; good condition; weight, fifteen kilos. 
Ether anesthesia. 

Initial blood-pressure, 170 mm.; stroke, 14 mm. The 
animal was reduced to shock by exposing and manipu- 
lating the intestines. Blood-pressure, 128 mm.; 
stroke, 4 mm. 

One one-hundred-and-twentieth grain of strychnin 
was injected at five-minute intervals. Following the 
first injection there was a rise in the blood-pressure. 
Blood-pressure, 140 mm. ; stroke, 4 mm. 
Following the second injection there was a fall of 5 
mm. in the blood-pressure. 

Following the third injection there was a slight rise 
of 5 mm. 

Following the fourth injection there was a fall of 
6 mm. 

Following the fifth injection there was a rise in the 
blood-pressure of 16 mm. 

Following the sixth injection there was a fall of 6 
mm., shortly followed by a further fall of 4 mm. 
Following the seventh injection the reflexes height- 
ened, with a rise of 25 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Following the eig-hth injection there was a fall in the 
blood-pressure of 25 mm. 

Following the ninth injection there was a convulsion, 
accompanied by a rise of 16 mm. 
Following the tenth injection, convulsions at regular 
intervals. Dm-ing the convulsion there was a slight 
rise in blood-pressure. 

Following the eleventh injection, convulsions, during 
which time there was a rise of 20 mm. in the pressure. 
Following the twelfth injection there was a fall of 20 
mm. in the blood-pressure. Convulsions continuous. 
Following the thirteenth and fourteenth injections, 
which were given during the convulsions, the animal 
died, with a blood-pressure of 10 mm. 
Time of experiment, three hours and forty-five min- 
utes. 

Experiment 62. 
Strychnin. 

Mongrel dog ; poor condition ; weight, two and one- 
half kilos. Ether anesthesia. 

Preliminary blood-pressure, 125 mm. ; stroke, 12 mm. 
The animal was reduced to shock by skinning the 
spine and sponging the denuded surface. Blood- 
pressure, 88 mm. ; stroke, 8 mm. 
One-twentieth grain of strychnin was injected. A 
continuous fall in the blood-pressure to the abscissa 
line followed. Animal's death was due to respiratory 
failure. 

Experiment 63. 
Strychnin. 

Mongrel dog; weight, nine kilos; good condition. 
Ether anesthesia. 

Preliminary blood-pressure, 106 mm. ; stroke, 7 mm. 
The animal was reduced to surgical shock. Blood- 
pressure, 98 mm. ; stroke, 8 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 79 

One-twentieth grain of strychnin was administered, 
followed by an immediate fall in the blood-pressure. 
Blood-pressure, 50 mm.; stroke, 10 mm. A slight 
convulsion appeared, during which the maximum 
blood-pressure was 94 mm. ; stroke, 10 mm. A fall 
in the blood-pressure followed. 

One-twentieth grain of strychnin was injected. An 
irregular rise in the blood-pressure followed. A con- 
vulsion ensued, after which the blood-pressure stead- 
ily fell until the death of the animal. 

Experiments 64, 65. 
Strychnin. Control. 

Dog I, male bull; excellent condition; weight, ten 
kilos. 

Dog 2, female bull ; excellent condition ; weight ten 
kilos. 

At 10.00, anesthesia was complete. 

At 10.37.30, the following observations were made: 

Dog I, blood-pressure, 130 mm.; stroke, 12 mm.; 

pulse, 160. 

Dog 2, blood-pressure, 100 mm.; stroke, 8 mm.; 
pulse, 160. 

At 10.41, the animals were reduced to shock by exposing the 

intestines, stomach, and spleen. 
At 1 1.04.30, dog I, blood-pressure, 145 mm.; stroke, 10 mm.; 

pulse, 136; respiration, 140. 

Dog 2, blood-pressure, 100 mm.; stroke, 6 mm.; 
pulse, 124; respiration, 80. 

At 1 1. 1 9, the femoral vein in each animal was exposed. 

At 11.28, the intestines of both animals were roughly manipu- 
lated. 

At 1 1.28.30, dog I, blood-pressure, 112 mm.; stroke, 8 mm.; 
pulse, 128; respiration, 108. 

Dog 2, blood-pressure, 88 mm. ; stroke, 6 mm. ; pulse, 
112; respiration, 72. 



8o ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.23, dog i> blood-pressure, 112 mm.; stroke, 12 mm.; 
pulse, 132; respiration, 76. 

Dog 2, blood-pressure, 90 mm. ; stroke, 8 mm. ; 
pulse, 108; respiration, 68. 
At 12. 27, dog 2, an injection of V12 grain of strychnin was 
given. 

Dog I, the same amount of saline was injected. 
At 12.28.30, dog I, blood-pressure, 104 mm.; stroke, 12 mm. 
pulse, 124; respiration, 64. 

Dog 2, blood-pressure, 84 mm. ; stroke, 10 mm. 
pulse, 88 ; respiration, 40. 
At 12.37, ^^S I' blood-pressure, 105 mm.; stroke, 14 mm. 
pulse, 132; respiration, 80. 

Dog 2, blood-pressure, 80 mm.; stroke, 10 mm. 
pulse, 116; respiration, 80. 
At 12.52, dog I, blood-pressure, 108 mm.; stroke, 14 mm. 
pulse, 142 ; respiration, 68. 

Dog 2, blood-pressure, 75 mm.; stroke, 12 mm. 
pulse, 96; respiration, 76. 
At 12. 55, dog 2, an injection of V40 grain of strychnin was 
given. 

Dog I, same amount of saline was administered. 
Dog I, blood-pressure, 108 mm.; stroke, 14 mm. 
pulse, 144; respiration, 72. 

Dog 2, blood-pressure, 75 mm.; stroke, 12 mm. 
pulse, 92; respiration, 61. 
At 1.07, dog I, blood-pressure, no mm.; stroke, 14 mm. 
pulse, 132; respiration, 72. 

Dog 2, blood-pressure, 72 mm. ; stroke, 14 mm. 
pulse, 84; respiration, 64. 
At 1.33.30, dog I, blood-pressure, no mm.; stroke, 10 mm. 
pulse, 136; respiration, 64. 

Dog 2, blood-pressure, 78 mm. ; stroke, 10 mm. 
pulse, 96; respiration, 64. 
At 1. 55, dog I, blood-pressure, 102 mm.; stroke, 12 mm. 
pulse, 128; respiration, 72. 

Dog 2, blood-pressure, 72 mm.; stroke, 12 mm. 
pulse, 92; respiration, 56. 



ON THE BLOOD-PRESSURE IN SURGERY. gl 

At 2.05, dog I, blood-pressure, 100 mm.; stroke, 10 mm.; 
pulse, 140; respiration, 68. 

Dog 2, blood-pressure, 80 mm.; stroke, 12 mm.; 
pulse, 92 ; respiration, 56. 
At 2.53, dog I, blood-pressure, 90 mm. ; stroke, 10 mm. ; pulse, 
128; respiration, 64. 

Dog 2, blood-pressure, 76 mm.; stroke, 12 mm.; 
pulse, 84; respiration, 60. 

At 2.54, an injection of ^/^q grain of strychnin dissolved in 
22 minims of normal saline solution was given to 
dog 2 ; the same amount 'of normal saline was ad- 
ministered to dog I. 

At 2.55, dog I, blood-pressure, 85 mm. ; stroke, 10 mm. ; pulse, 
136; respiration, 72. 

Dog 2, blood-pressure, 74 mm.; stroke, 12 mm.; 
pulse, 84; respiration, 52. 
At 3.30, dog I, blood-pressure, 92 mm. ; stroke, 10 mm. ; pulse, 
120; respiration, 64. 

Dog 2, blood-pressure, 80 mm.; stroke, 12 mm.; 
pulse, 84; respiration, 48. 
At 4.20, dog I, blood-pressure, 98 mm.; stroke, 10 mm.; 
pulse, 128; respiration, 32. 

Dog 2, blood-pressure, 80 mm.; stroke, 12 mm.; 

pulse, 84; respiration, 44. 
At 4.23.30, dog 2, V40 grain of strychnin was injected. 

Dog I, the same amount of normal saline was given. 
At 4.46, dog I, blood-pressure, 95 mm.; stroke, lomm. ; pulse, 

124. 

Dog 2, blood-pressure, 72 mm.; stroke, 12 mm.; 

pulse, 76 ; respiration, 44. 
At 5.05, dog I, blood-pressure, 108 mm.; stroke, 10 mm.; 

pulse, 120; respiration, 36. 
At 5.06, dog 2, blood-pressure, 76 mm. ; stroke, 12 mm. ; pulse, 

80 ; respiration, 44. 
At 5.18, dog I, blood-pressure, 108 mm.; stroke, 10 mm.; 

pulse, 132; respiration, 74. 

Dog 2, blood-pressure, 80; stroke, 10 mm.; pulse, 
6 



82 ON THE BLOOD-PRESSURE IN SURGERY. 



76; respiration, 44. The intestines were manipu- 
lated. 

At 5.20, blood-pressure, 100 mm. ; stroke, 10 mm. 

Dog 2, blood-pressure, 65 mm. ; stroke, 12 mm. Me- 
chanical stimulations of the sciatic were applied. 

At 5.25, dog I, blood-pressure, 92 mm.; stroke, 8 mm. 

Dog 2, blood-pressure, 95 mm. ; stroke, 6 mm. The 
intestines were manipulated. 

At 5.28, dog I, blood-pressure, 86 mm. ; stroke, 8 mm. 

Dog 2, blood-pressure, 84 mm. ; stroke, 6 mm. Both 
hind feet were bnrned. 

At 5.50, dog I, blood-pressure, 105 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 78 mm. ; stroke, 8 mm. Both 
hind feet were burned. 

From 5.50 to 6.10 the sciatics were stimulated and 
the intestines were manipulated. 
At 6.09, dog I, blood-pressure, 80 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 102 mm. ; stroke, 7 mm. Both 
animals were killed with MgS04. 

Experiment 66. 
Whiskey, Adrenalin, Strychnin, Digitalis. 

Male mongrel dog ; fair condition ; weight, ten kilos. 
At 1 1.45, initial blood-pressure, 124 mm. 

At 1 1.47, an injection of V90 grain of strychnin was made. 

The length of the stroke was slightly increased, but 
no change occurred in the blood-pressure. 

At 11.50,25 minims of whiskey were injected. A greater in- 
crease occurred in the stroke without alteration of 
the blood-pressure. 

At 1 1.52, 10 minims of tincture of digitalis were injected. A 
slight increase in the blood-pressure occurred. 

At 11.57, blood-pressure, 120 mm. 

At 12.00, 15 minims of a i to 1000 solution of adrenalin chlo- 
rid were injected. The blood-pressure rose sharply 
to 240 mm. ; a marked slowing of the heart was in- 



ON THE BLOOD-PRESSURE IN SURGERY. 



augurated. The blood-pressure soon fell, but later 
was maintained at i6o mm. for three hours, by con- 
tinuotis injection of adrenalin in solution i to looo. 
The digitalis action of the adrenalin, from the heart, 
was controlled by atropin. 

EXPEBIMENT 67. 

Mixed Effect of Drugs. 

Dog; weight, eight kilos; good physical condition. 
Morphin and ether anesthesia. 

The animal was reduced to surgical shock by dissec- 
tion and exposure of the abdominal viscera, manipu- 
lation of the somatic area, and crushing of the paws. 
The blood-pressure was reduced to 46 mm. After 
twenty minutes it was further reduced to 36 mnl.. 
An injection of "'/igo grain of strychnin was given 
into the jugular vein. A slight wavering of the 
blood-pressure, followed by a rise, was noted. The 
pressure remained steadily at 38 mm. 
Four minims of tincture of digitalis was injected into 
the jugular vein ; in five minutes there was a slight 
rise, the ascent being very gradual. In ten minutes, 
20 minims of brandy were injected into the jugular 
vein. The heart-strokes became longer and the blood- 
pressure declined 3 mm. After ten minutes the blood- 
pressure became steady. ; ,\. 
An injection of V120 grain of nitroglycerin was given 
into the jugular vein. The blood-pressure immedi- 
ately fell, followed by a compensatory rise to the pre- 
vious level. This entire routine was repeated. The 
strychnin produced a rise, the digitalis a trifle greater 
rise, the alcohol and nitroglycerin a fall, the final 
result being a slight elevation in the blood-pressure. 
After this ^/igo grain of strychnin was given. This 
was followed by a rise. One dram of alcohol was 
followed by a fall, a little greater than the rise which 



84 ON THE BLOOD-PRESSURE IN SURGERY. 



followed the strychnin. Five minims of digitalis pro- 
duced a rise, which was steady and well sustained. 
Ten minutes later ^/go grain of nitroglycerin was fol- 
lowed by a fall. The respiration became extremely 
irregular, the heart-strokes shorter. The animal died 
of respiratory failure. 

Experiments 68, 69. 
Strychnin. Control. 

Dog I, male; old and poor condition; weight, five 
kilos. 

Dog 2, mongrel ; good condition ; middle-aged ; 

weight, eight kilos. 
At lo.oo, both animals were placed under anesthesia. 
At 10.15, dog I, the control, showed a normal blood-pressure of 

112 mm. ; stroke, 9 mm. 

Dog 2, the experiment animal, blood-pressure, 160 
mm.; stroke, 14mm. 
At 10.30, the intestines of both animals were exposed and ma- 
nipulated. 

At 10.45, dog I, blood-pressure, 98 mm. ; stroke, 6 mm. 

Dog 2, blood-pressure, 120 mm.; stroke, 8 mm. 
At 1 1. 1 5, dog I, blood-pressure, 90 mm.; stroke, 9 mm. 

Dog 2, blood-pressure, 118 mm.; stroke, 9 mm. 
At 1 1. 17, an injection of Voo grain of strychnin in 22 minims 

of normal saline was given to dog 2, and an equal 

quantity of normal saline to dog i . 
At 1 1. 1 8, dog I, blood-pressure, 100 mm. ; stroke, 10 mm. 

Dog 2, blood-pressure, 126 mm.; stroke, 9 mm. 
At 1 1. 21, dog I, blood-pressure, 92 mm. ; stroke, 8 mm. 

Dog 2, blood-pressure, 105 mm. ; stroke, 10 mm. 
At 11.28, dog I, blood-pressure, 82 mm. ; stroke, 9 mm. 

Dog 2, blood-pressure, 103 mm. ; stroke, 10 mm. 
At 1 1.3 1, dog I, blood-pressure, 86 mm. ; stroke, 10 mm. 

Dog 2, blood-pressure, 112 mm.; stroke, 9 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. gs 



At 1 1.35, dog I, blood-pressure, 88 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, no mm. ; stroke, 10 mm. 

At 1 1.40, dog I, blood-pressure, 83 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 106 mm. ; stroke, 9 mm. 

At 1 1.44, dog I, blood-pressure, 88 mm.; stroke, 12 mm. 

Dog 2, blood-pressure, 115 mm.; stroke, 10 mm. 

At 11.46, dog I, an injection of Voo grain of strychnin in 22 
minims of saline solution was given. 
Dog 2, the same amount of normal saline was admin- 
istered. 

At 11.47, i> blood-pressure, 80 mm. ; stroke, 10 mm. 

Dog 2, blood-pressure, 112 mm.; stroke, 12 mm. 
At 1 1. 50, dog I, blood-pressure, 82 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 130 mm.; stroke, 10 mm. 
At 1 1.52, dog I, blood-pressure, 80 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 133 mm. ; stroke, 9 mm. 
At 1 1.55, dog I, blood-pressure, 78 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, ii6mm. ; stroke, 10 mm. 
At 1 1.57.30, dog I, blood-pressure, 78 mm.; stroke, 12 mm. 

Dog 2, blood-pressure, 120 mm. ; stroke, 12 mm. 
At 12.00.30, dog I, blood-pressure, 80 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 1 18 mm. ; stroke, 10 mm. 
At 1 2. 08, dog I, blood-pressure, 82 mm.; stroke, 12 mm. 

Dog 2, blood-pressure, 94 mm. ; stroke, 10 mm. 
At 12. 10, dog I, blood-pressure, 83 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 94 mm. ; stroke, 10 mm. 
At 12. 1 1, dog I, blood-pressure, 83 mm. ; stroke, 10 mm. 

Dog 2, blood-pressure, 118 mm. ; stroke, 10 mm. 
At 12. 14, dog I, blood-pressure, 88 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, no mm. ; stroke, 10 mm. 
At 12. 18, dog I, blood-pressure, 82 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 97 mm. ; stroke, 10 mm. 
At 12.21, dog I, blood-pressure, 82 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 80 mm. ; stroke, 10 mm. 
At 12.21. 30,dog I, blood-pressure, 82 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 93 mm. ; stroke, 10 mm. 



I 



86 ON THE BLOOD-PRESSURE IN SURGERY. 

At 12. 22, dog I, an injection of Voo grain of strychnin was 
given in 22 minims of normal saline solution. 
Dog 2, the same amount of saline was injected. 

At 12.31.30, dog I, blood-pressure, 100; stroke, 10 mm. 

Dog 2, blood-pressure, 59 mm.; stroke, 12 mm. 

At 12.35.30, dog I, blood-pressure, 80 mm. ; stroke, 10 mm. 
Dog 2, blood-pressure, 53 mm.; stroke, 16 mm. 

At 12.37, Dog I' blood-pressure, 80 mm.; stroke, 12 mm. 

Dog 2, blood-pressure, 50 mm. ; stroke, 1 5 mm. 

At 12.38.30, dog I, blood-pressure, 80 mm.; stroke, 12 mm. 
Dog 2, blood-pressure, 52 mm.; stroke, 18 mm. 

At 12.39, dog I, blood-pressure, 78 mm. ; stroke, 10 mm. 
Dog 2, blood-pressure, 7 mm. ; stroke, o. 

From 12.38 to 12.42 the respiration decreased in rate and vol- 
ume, and was of a typical vagal character. 
Dog I, blood-pressure, 80 mm.; stroke, 10 mm. 
Dog 2, blood-pressure, 42 mm. ; stroke, 24 mm. 

At 12.43, <^og 2 died of respiratory failure. 

Dog I, blood-pressure, 78 mm. ; stroke, 10 mm. 

Remarks. — A slight corneal reflex was present in each dog. 

Dog I, the blood-pressure was remarkably irregular. 
Dog 2, the blood-pressure was remarkably irregular. 
There occurred a slight rise in the blood-pressure, fol- 
lowing the injection of strychnin, but it was not 
marked, nor well sustained. 
Dog I, in shock. No further manipulation. 

At 12. 50, dog I, blood-pressure, 90 mm.; stroke, 10 mm. 

At 1. 00, dog I, blood-pressure, 90 mm.; stroke, 10 mm. 

At 1. 10, dog I, blood-pressure, 88 mm.; stroke, 12 mm. 

At 1. 20, dog I, blood-pressure, 92 mm.; stroke, 10 mm. 

At 1. 30, dog I, blood-pressure, 92 mm.; stroke, 10 mm. 

At 1. 42, dog I, blood-pressure, 92 mm.; stroke, 10 mm. 

At 2.00, dog I, blood-pressure, 96 mm.; stroke, 10 mm. 

At 2.30, dog I, blood-pressure, 95 mm.; clot. 

At 2.31, dog I, blood-pressure, 78 mm.; stroke, 8 mm. 

At 2.35, dog I, blood-pressure, 65 mm.; stroke, 10 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 

At 3.00, dog I, blood-pressure, 58 mm.; stroke, 12 mm. 
At 3. 10, dog I, blood-pressure, 64 mm.; stroke, 12 mm. 
At 3.37, dog I, blood-pressure, 58 mm.; stroke, 10 mm. 
At 4.42, dog I , blood-pressure, 74 mm. ; stroke, 6 mm. The 

dog was killed with MgS04. The animal was in 

good condition. 

Remarks. — After inducing shock, the animals were not further 
depressed. Both received the same amount of saline, 
and were manipulated in exactly the same manner. 

Experiment 70. 
Asphyxia. Strychnin. 

Dog ; mongrel male ; fair condition ; old ; weight, 
four kilos. 

Initial blood-pressure, 180 mm.; pulse, 176; length 
of stroke, 10 mm. 

While executing the technique for bloodlessly sever- 
ing the accelerantes and the vagi, the respiration tube 
was inadvertently kinked, causing the blood-pressure 
to fall to 10 mm. The pulse recorded 12 and there 
was extreme cyanosis. The animal was almost dead. 
Artificial respiration was resorted to, but there was 
apparently no progress towards recovery. 
One-tenth of a grain of strychnin was injected into 
the jugular vein. Blood-pressure rose to 40 mm. ; 
stroke, 25 mm. Moderate convulsions were noted; 
these were overcome by the administration of 2.6 
drams of .5 per cent, solution of curare. The blood- 
pressure then continued to rise until it reached 
200 mm. 

At 12.10, blood-pressure, 200 mm. ; pulse, 200; stroke, 40 mm. 
At 12.34, blood-pressure, 165 mm. 
At 12.54, blood-pressure, 80 mm. 

At 1.09, blood-pressure, 50 mm. The animal was then killed. 



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ON THE BLOOD-PRESSURE IN SURGERY. 



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ON THE BLOOD-PRESSURE IN SURGERY. 

Experiment '71. 
Mixed Effect of Drugs. 

Dog ; weight, seven kilos ; the animal had a large 
thyroid gland. Morphin and ether anesthesia. 
Initial blood-pressure, 124 mm. 
The animal was redvtced to surgical shock by ex- 
posure and manipulation of the splanchnic area and 
the nerve-trunks of the limb. 

An injection of ^/igo grain of strychnin was given 
into the jugular vein. No effect was observed. In 
ten minutes the blood-pressure had fallen lower. 
Four minims of tincture of digitalis was followed 
by a momentary fall, after which a steady rise be- 
gan. After the maximum had been reached, half 
a dram of brandy was injected into the jugular vein. 
The blood-pressure immediately fell. The heart- 
strokes were lengthened and the respiration deepened. 
After the pressure was partially recovered, ^/iso 
grain of nitroglycerin produced a marked fall in the 
blood-pressure, with a compensation of 3 mm. The 
same routine was repeated three times, at the end 
of which the animal seemed exhausted. The blood- 
pressure began to decline, and the animal soon died. 

Experiment 72. 
Mixed Effect of Drugs, 

Dog; weight, sixteen kilos. Morphin and ether an- 
esthesia. 

Initial blood-pressure, 144 mm. 

The dog was reduced to surgical shock after forty- 
five minutes of severe manipulation. 
An injection of Viso grain of nitroglycerin was made 
into the jugular vein. This was followed by a fall 
of 5 mm. in the blood-pressure. The compensation 
being but partial, 4 minims of tincture of digitalis 



ON THE BLOOD-PRESSURE IN SURGERY. 



were given. A. slight but steady rise in the blood- 
pressure followed. 

One-half dram of brandy was injected into the jugu- 
lar vein. This was followed by a momentary rise, 
after which there was a decline in the blood-pressure, 
without compensation. An immediate fall, muscular 
twitchings, and gasping respirations followed the ad- 
ministration of V90 grain of strychnin. A marked 
fall in the blood-pressure followed. Respiration 
failed and the animal died. 

Experiment 73. 
Mixed Effect of Drugs. 

Dog ; weight, seven kilos. Morphin and ether anes- 
thesia. 

Blood-pressure, 128 mm. 

The animal was reduced to surgical shock by somatic 
and splanchnic manipulation. 

Blood-pressure, 36 mm. The animal was rapidly fail- 
ing. The respirations were irregular. 
An injection of Viso grain of strychnin w^as given 
into the jugular vein. No effect beyond a trifling 
momentary rise was noted. 

Four minims of tincture of digitalis were followed by 
a slight rise. 

The administration of \/i8o grain of nitroglycerin 
was followed by a temporary fall, after which com- 
pensation occurred. 

One-half dram of brandy was followed by a wavering 
line for ten seconds, then a distinct fall. 
The application of the Bunsen flame to the left hind 
foot for four seconds was followed by a decided rise 
in the blood-pressure. Compensation, lasting twenty 
minutes, followed the burning. The blood-pressure 
was maintained higher by repeated burning. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 74. 
Mixed Effect of Drugs, 

Dog; poor condition, weight, five kilos. Morphin 

and ether anesthesia. 

Initial blood-pressure, io6 mm. 

The animal was reduced to shock by manipulation of 
the somatic and splanchnic area. 

The administration of Vsoo grain of nitroglycerin 
was followed by a marked fall in the blood-pressure. 
Compensation was not complete. 

An injection of "^/jgo grain of strychnin was followed 
by a wavering line, and then a slight rise. 
Three minims of tincture of digitalis were injected. 
A steady rise in the blood-pressure was noted. Grad- 
ual burning of the left hind foot produced a very 
marked rise. This rise was sustained by slowly 
scorching the paws. After the effect began to wear 
out in one paw, another was stimulated in similar 
manner so that the blood-pressure was maintained 
for twenty minutes. The animal was then killed. 

Experiment 75. 

Mixed Effect of Drugs, — Strychnin, Digitalis, and 
Normal Saline. 

Dog; male mongrel; weight, six kilos. Morphin and 
ether anesthesia. 
At 11.45, blood-pressure, 120 mm.; pulse, 176; respiration, 
116. 

At 1 1.46, the intestines were exposed and manipulated, and 
the hind feet and tail crushed. 

At 1 1.50, blood-pressure, 75 mm.; pulse, 150; respiration, 108. 

At 11.51,^/30 grain of strychnin sulphate was injected into the 
femoral veins. An immediate fall in the blood-press- 
ure followed. 



92 ON THE BLOOD-PRESSURE IN SURGERY. 

At 1 1.52, blood-pressure, 45 mm. ; pulse, 144; respiration, 46. 

Occasional convulsions were noted, and the blood- 
pressure was slowly rising. 

At 1 1.54, blood-pressure, 75 mm.; pulse, 180; respiration, 76. 

At 11.55, 15 minims of tincture of digitalis were injected into 
the femoral vein. Blood-pressure, 55 mm., the fall 
being very rapid. Blood-pressure slowly rose to 
no mm. Respiration ceased; artificial respiration 
was supplied. 

At 1 1.57, blood-pressure, 90 mm.; pulse, 80. 

At 12.02, blood-pressure, 100 mm. ; pulse, 180; respiration, 60. 

At 12.03, 25 minims of whiskey were injected. The blood- 
pressure rapidly fell to 60 mm., then slowly rose to 
100 mm. 

At 12.08, blood-pressure, 100 mm. ; pulse, 160 ; respiration, 60. 
At 12.09, injection of 10.75 ounces of normal saline solution 

was given. Blood-pressure, 120 mm., soon falling to 

100 mm. 

At 12. 1 1, blood-pressure, 100 mm.; pulse, 156; respiration, 
72 ; the pulse was very much stronger, the excursions 
greater; the respirations deeper, but irregular and 
more labored. 

At 12.13, the left hind foot was burned. A rise in the blood- 
pressure followed. 

At 12.14, blood-pressure, 130 mm.; pulse, 180; respiration, 
84. 

Experiment 76. 

Mixed Effect of Drugs, — Strychnin, Normal Saline, and 
Pneumatic Tube. 

Dog; male; weight, six kilos ; good condition. Mor- 
phin and ether anesthesia. 

At 9.27, blood-pressure, 100 mm. ; pulse, 102; respiration, 72. 

Shock was produced by exposing and manipulating 
the intestines, crushing the legs and toes, and lacer- 
ating the testicles. 

At 9.33, blood-pressure, 70 mm.; pulse, 102; respiration, 84. 



ON THE BLOOD-PRESSURE IN SURGERY. 93 

At 9.35, blood-pressure, 50 mm.; the animal was in profound 
shock. 

At 9.38, an injection of ^/qq grain of strychnin sulphate was 
made. 

At 9.43, blood-pressure, 36 mm.; pulse, 132; respiration, 62. 
The heart was weak and the excursions were small. 

At 9.45, an injection of 10 ounces of normal saline was given 
into the femoral vein. 

At 9.47, blood-pressure, 60 mm.; pulse, 108; respiration, 40 
and very labored. 

At9.50,the animal was placed in the tube, blood-pressure, 50 
mm.; pulse, 120; respiration, 44. 

At 9.55, tube-pressure, no mm. A clot in the carotid cannula 
necessitated removal of the animal. 

At 9.58, the pulse and respiration were in good condition. 

At 10.00, the animal was replaced in the tube. 

At 10.05, tube-pressure, 60 mm.; blood-pressure, 100 mm.; 
pulse, 72; respiration, 36. 

At 10.05, slight convulsions, due to strychnin, appeared. 

At 10.20, the animal was removed from the tube in fair condi- 
tion. Blood-pressure, 70 mm. ; pulse, 80 ; respira- 
tion, 48. The animal was used for other experi- 
ments. 

Experiment 77. 

Death from Collapse. 

Mongrel dog ; fair condition ; weight, nine kilos. 
Ether anesthesia ; tracheal and carotid cannulae were 
adjusted. 

The initial blood-pressure was 120 mm.; stroke, 12 
mm. ; pulse, 140. 

While dissecting out the accelerantes the animal 
suddenly died. The exact cause of death could not 
be determined. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 78. 
Chloroform Death. 

Mongrel; weight, twelve kilos; good condition. 
Ether anesthesia. 

After the skin dissection over the abdomen was made, 
chloroform was given, in excess. The blood-pressure 
fell rapidly. Respiration ceased. 
One-fortieth grain of strychnin was injected into the 
jugular vein. No change in the blood-pressure fol- 
lowed. The animal speedily died. 

Experiment 79. 
Strychnin, Adrenalin, and other Experiments. 

Mongrel dog ; good condition ; weight, nine kilos. 
Control blood-pressure, 130 mm.; pulse, 180; stroke, 
8 mm. 

The animal was reduced to shock by skinning and 
sponging the raw surfaces. 

At 10.34, blood-pressure, 30 mm. ; pulse, 120; stroke, 10 mm. 

At 10.36, the sciatic nerve was electrically stimulated; no 
change occurred in the blood-pressure. Intravenous 
injection of adrenalin, i to 200,000, at the rate of 
y2 ounce per minute, raised the blood-pressure to 
1 10 mm. 

The finger was introduced into the larynx and pressure 
exerted. The heart immediately stopped and the 
blood-pressure fell to 40 mm. The rate was greatly 
diminished, then suddenly increased, the blood-press- 
ure rising to 90 mm., and later recording 110 mm. 
The injection of ^/i2o grain of nitroglycerin was 
given; blood-pressure 80 mm. 

The injection was repeated ; blood-pressure, 60 mm. 
The blood-pressure soon returned to the former level. 
The animal was killed. 



ON THE BLOOD-PRESSURE IN SURGERY. 




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96 ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 80. 
Adrenalin, Strychnin, and Atropin. 

Mongrel dog; good condition; weight, sixteen 
pounds. Ether anesthesia. The preliminary obser- 
vations were : 

At 2.30, blood-pressure, 140 mm.; pulse, 152; stroke, 11 mm. 

At 2.40, the paw was burned and the sciatic nerve stimulated. 

A sharp rise, followed by a fall, making a curve of 
25 mm., resulting. 

At 2.43, the integument was removed. 

At 5.42, blood-pressure, 55 mm.; stroke, 7 mm. 

At 5.51.30, an injection of 22 minims of adrenalin chlorid was 
given. Blood-pressure, 105 mm. 

At 5.53.30, the heart showed excessive stimulation of the vagal 
mechanism. The length of stroke increased from 5 
to 70 mm. One-thirtieth grain of atropin was admin- 
istered. The strokes immediately decreased to 10 
mm., and a gradual fall occurred in the blood- 
pressure. 

At 6.12, blood-pressure, 20 mm. 

At 6.17, a continuous injection of adrenalin chlorid in normal 
saline solution, in the proportion of i to 100,000, was 
given. Blood-pressure, 80 mm. ; pulse, 128. 

At 6.23, no effect was produced by burning the paw. 

At 6.25, the injection of Vis grain of strychnin produced no 
change. The animal was killed. 

Experiment 81. 
Shock, Strychnin, Vasomotor Centre. 

Dog ; male mongrel ; good condition ; weight, five 
kilos. 

At 12.05, the initial blood-pressure was 125 mm.; stroke, 8 
mm. ; pulse, 124. 

At 1 2. 3 7, both vagi and accelerantes were severed. Blood- 
pressure, no mm.; pulse, 134. 



ON THE BLOOD-PRESSURE IN SURGERY. 



97 




gg ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.45, the animal was reduced to surgical shock by skinning, 
sponging the denuded surfaces, and manipulating the 
intestines. 

At 1.45, blood-pressure, 50 mm. ; pulse, 76. 

At 1.49, respiration failed; artificial respiration was begun. 

Blood-pressure, 35 mm. ; pulse, 76. 
At 2.00, ^ ounce of a .5 per cent, solution of curare was 

intravenously injected. 
At 2.01.30, -^/go grain of strychnin was intravenously injected. 

A very slight change in the blood-pressure followed. 
At 2.05,^/90 grain of strychnin was intravenously injected. 

No change in the blood-pressure was obtained. 
At 2.06, ^/so grain of strychnin was intravenously injected. A 

slight fall in the blood-pressure was noted. 
At 2.07, blood-pressure, 14 mm.; stroke, 8 mm.; pulse, 68. 
At 2.09, the sciatic nerve was electrically stimulated. No 

change in the blood-pressure was recorded. 
At 2.20, stimulation of the splanchnic nerve, peripheral and 

central, produced no apparent effect. 
At 2.25, -^/is grain of strychnin was injected intravenously. 

No change was observed. 
At 2.28, the animal died. Blood-pressure, 5 mm. at the moment 

of death. 

Experiment 82. 
Curare, Strychnin, Saline Infusion, Adrenalin. 

Female mongrel dog ; fair condition ; weight, seven- 
teen kilos. 

At 10.14, initial blood-pressure, 125 mm.; stroke, 12 mm.; 

pulse, 172. Both the accelerantes and vagi were sev- 
ered. 

At 10.23, blood-pressure, 14° mm.; pulse, 180. 2.6 drams of 
a .5 per cent, solution of curare were injected. The 
blood-pressure fell to 1 5 mm. 

At 10.41, blood-pressure, 28 mm. 

At 10.50, blood-pressure, 50 mm. ; stroke, 12 mm. 

At 10.58, blood-pressure, 70 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. gg 

At 1 1. 14, blood-pressure, 30 mm. ; stroke, 4 mm. 

At 1 1. 14.30, ^/i5 grain of strychnin was injected. No change 

occurred in the blood-pressure. 
At 11.28, the injection of 8.25 ounces of normal saline solution 

was begun. 

At 1 1.32, burning the paw produced no effect. 
At 1 1.33, ^/so grain of strychnin was injected. No change was 
observed. 

At 1 1.36, blood-pressure, 35 mm. Twenty-five minims of i to 
1000 solution of adrenalin chlorid were injected. 
The blood-pressure recorded 180 mm. The stroke 
increased. 

At 11.40, blood-pressure, 20 mm. Repeated injections of adre- 
nalin caused a similar rise. The animal was killed. 

Experiment 83. 
Curare, Strychnin, Saline Infusion. 

Female dog ; good condition ; weight, six kilos. 

At 1.59, initial blood-pressure, 100 mm. ; stroke, 11 mm. Fif- 
teen c.c. of a .5 per cent, solution of curare were 
injected. Blood-pressure, 30 mm. ; stroke, 8 mm. 

At 2. 1 5, the injection of ^/go grain of strychnin was given. 

At 2. 1 6, a rise occurred in the blood-pressure. 

At 2.24, blood-pressure was at its maximum height. Blood- 
pressure, 130 mm.; stroke, 15 mm. 

At 2.33, blood-pressure, 120 mm.; stroke, 8 mm.; pulse, 192. 

At 2.36, blood-pressure, 100 mm.; stroke, 8 mm.; pulse, 190. 

At 2.41, blood-pressure, 50 mm.; stroke, 6 mm.; pulse, 200. 
The blood-pressure fell rapidly. 

At 2.43, the administration of ^/^q grain of strychnin was fol- 
lowed by a gradual fall. 

At 2.46, blood-pressure, 30 mm.; stroke, 10 mm. 

At 2.47, ^/go grain of strychnin was injected. 

At 2.48, blood-pressure, 25 mm.; stroke, 9 mm. 

At 2.49, burning the hind foot produced no change. 

At 2.52, an infusion of saline was given. A gradual rise fol- 
lowed. 



1 



lOO ON THE BLOOD-PRESSURE IN SURGERY. 

At 2.59, blood-pressure, 140 mm. ; stroke, 180 mm. 
At 3.00, a gradual fall began. 

At 3.15, blood-pressure, 50 mm. The animal was killed. 

Experiment 84. 

Shock, Curare, Strychnin. Splanchnic Nerve, Vagi, and 
Accelerantes severed. 

Female mongrel dog ; good condition ; weight, twelve 
kilos. 

At 1.57, initial blood-pressure, 135 mm.; stroke, 12 mm.; 
pulse, 152. 

At 2. 10, the accelerantes and vagi were exposed by bloodless 

dissection and severed. Blood-pressure, 120 mm.; 

stroke, 15 mm.; pulse, 140. 
At 2. 19, .75 ounce of a .5 per cent, solution of curare was 

intravenously injected. Artificial respiration was 

begun. 

At 2.43, blood-pressure, 120 mm.; stroke, 115 mm.; pulse, 120. 
At 2.46, ^/75 grain of strychnin was given, following which 

there was a sharp rise in the blood-pressure, reaching 

220 mm.; stroke, 20 mm.; pulse, 124. 
At 2.47.30, the heart became intermittent. The style executed 

excursions of 40 mm. 
At 2.48.30, blood-pressure, 200 mm.; stroke, 40 mm.; pulse, 

136. 

At 2.59, blood-pressure, 185; stroke, 30 mm.; pulse, 146. 

At 3.03, -'/go grain of strychnin was intravenously injected. A 

sharp rise in the blood-pressure to 200 mm. was 

noted. 

At 3.1 1, blood-pressure, 185 mm.; stroke, 35 mm.; pulse, 148. 
At 3.14, ^/.jo grain of strychnin was intravenously injected. 

No change in the blood-pressure was noted. The 

stroke decreased in length to 20 mm. 
At 3.21, blood-pressure, 175 mm.; stroke, 30 mm.; pulse, 132. 
At 3.21.30, V30 grain of strychnin was intravenously injected; 

no effect upon the blood-pressure was observed. 




I 



102 



ON THE BLOOD-PRESSURE IN SURGERY. 




6n the blood-pressure in surgery. 



103 




ON THE BLOOD-PRESSURE IN SURGERY. 



At 3.23, a steady decline in the blood-pressure began. 

At 3.31, blood-pressure, 160 mm. ; stroke, 12 mm.; pulse, 132 

At 3.31.30, electrical stimulation of the sciatic nerve was fol- 
lowed by a gradual rise of 35 mm. in the blood- 
pressure; later, an abrupt fall of 45 mm. occurred. 
The blood-pressure remained constant at 140 mm. 

At 3.32.15, V 

30 grain of strychnin was intravenously injected. 
The blood-pressure rose 20 mm. and fell an equal 
amount in seven minutes. 

At 3.39, blood-pressure, 130 mm. Electrical stimulation of the 
sciatic nerve caused an abrupt rise of 20 mm., fol- 
lowed by an equal fall. 

At 3.45, blood-pressure, 140 mm. 

At 3.48, blood-pressure, 120 mm., after which at intervals of 
one minute six injections of Vso grain of strychnin 
were given intravenously. The blood-pressure de- 
clined from 120 to 40 mm.; stroke, 8 mm.; pulse, 
104. 

At 3.58, blood-pressure rose to 80 mm.; stroke, 10 mm; pulse, 

96. 

At 3.58.45, six more injections of ^/g^ grain of strychnin at 
intervals of one minute were given intravenously. 
The blood-pressure fell from 80 to 65 mm. ; the pulse, 
from 104 to 88. 

At 4.16, electrical stimulation of the sciatic nerve was followed 
by a slight rise in the blood-pressure. 

At 4.50, similar stimulation produced no effect. The electrical 
stimulation of the distal end of the splanchnic nerve 
was followed by an irregular rise and fall. Similar 
stimulation of the central end produced no effect. 

At 5.05.30, blood-pressure, 40 mm.; stroke, 12 mm.; pulse. 

140. The right splanchnic nei"ve was then exposed, 
severed, and the distal end electrically stimulated. 
An abrupt rise of 25 mm. in the blood-pressure fol- 
lowed. Similar stimulation of the central end pro- 
duced no effect. 

At 5.08.30, blood-pressure, 30 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



At 5.09,^/15 grain of strychnin was intravenously injected. 
No change in the blood-pressvire was noted. 

At 5.13, electrical stimulation of the distal end of the splanch- 
nic nerve was followed by a gradual rise of 15 mm. 
in the blood-pressure. When the stimulation was 
withdrawn the blood-pressure declined an equal 
amount. 

At 5.14.30, blood-pressure, 30 mm.; stroke, 8 mm.; pulse, 92. 

At 5.16, ^/i5 grain of strychnin was intravenously injected. 

Electrical stimulation of the sciatic nerve now pro- 
duced no apparent change in the blood-pressure. 
Eight successive injections of four milligrams each 
of strychnin were administered intravenously at in- 
tervals of one minute. The blood-pressure remained 
at 30 mm.; stroke, 12 mm.; pulse, 56. 

At 6.12, the animal was allowed to die of asphyxia. There was 
no rise in the blood-pressure during its development. 
The heart continued to beat six minutes after artificial 
respiration had been discontinued. 

Experiment 85. 
Shock, Curare, Strychnin, Saline Solution. 

Female mongrel dog; good condition; weight, eight 
kilos. 

At 10.04, initial blood-pressure, 100 mm. ; pulse, 164; stroke, 
10 mm. 

At 10.05, the vagi and accelerantes were severed. 

At 10.24, blood-pressure, nS mm.; pulse, 144; stroke, 20 mm. 

There were injected Yz ounce of a .5 per cent, solu- 
tion of curare. 

At 1 1. 00, blood-pressure, 33 mm.; pulse, 144; stroke, 15 mm. 
At 11.01,^/30 grain of strychnin was injected. 
At 1 1.02.30, blood-pressure, 145 mm.; pulse, 140; stroke, 12 
mm. 

At 1 1 .04, blood-pressure, 150 mm.; stroke, 22 mm. 
At 1 1.05,73 0 grain of strychnin was injected. No variation 
in the blood-pressure was noted. 



I 



io6 



ON THE BLOOD-PRESSURE IN SURGERY. 




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ON THE BLOOD-PRESSURE IN SURGERY. 



At 1 1 . 1 7, blood-pressure, 150 mm. On stimulating the sciatic 
nerve the blood-pressure rose 20 mm. It later fell to 
its former level. 

At 1 1.3 1, blood-pressure, 146 mm. 

At 1 1.37, blood-pressure, 125 mm. 

At 1 1.45, blood-pressure, 100 mm. 

At 1 1.50, blood-pressure, 85 mm.; pulse, 140. 

At 12.03, blood-pressure, 60 mm. 

At 12.05,^/30 grain of strychnin was administered. 

At 12.06, blood-pressure, 120 mm. 

At 12.07.30, blood-pressure, no mm. Stimulating the sciatic 

nerve was followed by a slight rise. 
At 12.20, blood-pressure, 55 mm. 
At 12.34, blood-pressure, 50 mm. 

At 12.37, electrical stimulation of the sciatic nerve was followed 
by a slight rise. 

At 12.37.30, the injection of ^/go grain of strychnin caused no 
change in the blood-pressure. 

At 12.41, the infusion of saline was begun. 

At 12.51, 20 ounces of saline solution had been given. Blood- 
pressure, 140 mm.; pulse, 152; stroke, 12 mm. 

At 12.53, blood-pressure, 125 mm. 

At 1. 00, blood-pressure, 100 mm. 

At 1 .09, blood-pressure, 80 mm. 

At 1. 2 1, blood-pressure, 70 mm. 

At 1.22, ^/ao grain of strychnin was injected. A slight rise in 

the blood-pressure followed. 
At 1.27, blood-pressure, 53 mm. 
At 1.30, blood-pressure, 45 mm. 

At 1.38, blood-pressure, 45 mm. The animal was then killed. 

Experiment 86. 
Shock, Strychnin, Digitalis, Mechanical Support. 

Female mongrel dog ; good condition ; weight, seven 
kilos. 

At 10.07, initial blood-pressure, no mm.; pulse, 172; stroke, 
12 mm. Vagi and accelerantes were severed. Blood- 



ON THE BLOOD-PRESSURE IN SURGERY. 




ON THE BLOOD-PRESSURE IN SURGERY. 



pressure, 135 mm.; pulse, 148; stroke, 20 mm; res- 
piration failed. Artificial respiration having been 
supplied for a few moments, normal respiration was 
resumed. The animal was then reduced to shock by 
removing three-fourths of the integument and 
sponging the raw surfaces. 

At 1 1. 2 1, blood-pressure, 50 mm.; pulse, 96; stroke, 10 mm. 

Five and one-half drams of a .5 per cent, solution 
of curare were injected. The blood-pressure fell. 

At 1 1.30, blood-pressure, 30 mm.; pulse, 92; stroke, 11 mm. 

At I i.30.30,electrical stimulation of the sciatic nerve produced 
no appreciable effect. 

At 1 1.3 1, V15 grain of strychnin was injected. 

At 1 1.34, blood-pressure, 54 mm.; pulse. 84; stroke 11 mm. 

At 1 1.37, blood-pressure, 90 mm.; pulse, 84; stroke, 1 1 mm. 
A gradual fall in pressure now began. 

At 1 1. 4 1, blood-pressure, 85 mm.; pulse, 85; stroke, 11 mm. 

At 1 1.43, blood-pressure, 80 mm.; pulse, 88; stroke, 11 mm. 

At 1 1.43.30, blood-pressure, 75 mm.; pulse, 92; stroke 11 mm. 

At 1 1.47, blood-pressure, 65 mm.; pulse, 88; stroke, 11 mm. 

At 1 1.50, blood-pressure, 55 mm.; pulse, 100; stroke, 11 mm. 

At 1 1.53, blood-presure, 47 mm.; pulse, 104; stroke, 11 mm. 

At 12.00, blood-pressure, 40 mm. 

At 12.01, V30 grain of strychnin was injected. The fall in 
the blood-pressure continued. 

At 12.02, blood-pressure, 27 mm. ; pulse, 80. Electrical stimu- 
lation of the sciatics and burning of the paw produced 
no change in the blood-pressure. 

At 12.07, 10 minims of digitalis were injected. No change in 
the blood-pressure or pulse was observed. 

At 12.09, 5 minims of tincture of digitalis were injected. No 
effect upon blood-pressure or pulse was obtained. 

At 12.15, 5 niinims of whiskey were injected. A slight irregu- 
larity of the blood-pressure was noted. 

At 12.20, burning and stimulating the sciatics and the splanch- 
nics produced no change in the pressure or the pulse. 



no ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.26, blood-pressure, 25 mm. ; stroke, 10 mm. The animal 
was then bandaged, including the extremity and the 
trunk to the diaphragm. The blood-pressure rose to 
70 mm., and was well sustained. 

Experiment 87. 
Collapse, Hemorrhage, Strychnin, Saline Infusion. 

Dog ; female ; young and in good condition ; weight, 
six kilos. 

Normal blood-pressure, iiomm. ; pulse, 160; stroke, 
10 mm. 

At 10.51, both vagi and acceleranti were severed. Blood-press- 
ure, 105 mm.; pulse, 128; stroke, 13 mm. 

At 1 1. 01, 4.66 ounces of blood were removed. Blood-pressure, 
35 mm. ; stroke, 9 mm. 

At 1 1.02, 5.5 drams of a .5 per cent, solution of curare were 
injected. Blood-pressure, 10 mm.; stroke, 10 mm. 
Artificial respiration. 

At 11.14,^/90 grain of strychnin was injected; the blood- 
pressure rose 7 mm. ; stroke, 8 mm. 

At 1 1.20, blood-pressure, 20 mm; stroke, 9 mm. 

At 1 1.23, blood-pressure, 25 mm.; stroke, 6 mm.; pulse, 120. 

At 1 1.26, blood-pressure, 60 mm. 

At 1 1.28, blood-pressure, 90 mm. ; stroke, irregular. 

At 1 1.35, blood-pressure, 115 mm.; stroke, irregular. 

At 1 1.43, blood-pressure, 100 mm. ; stroke, irregular. 

At 1 1.48, blood-pressure, 80 mm. ; stroke, irregular. 

At 1 1.50, blood-pressure, 50 mm.; stroke, irregular; pulse, 
140. 

Atii.53, V90 grain of strychnin was injected. The blood- 
pressure in the mean time had fallen to 35 mm., and 
remained constant. 

At 1 1.55, the paw was burned. No change occurred in the 
blood-pressure. 

At 1 2. 02, the infusion of 15 ounces of normal saline solution 
was begun. 



ON THE BLOOD-PRESSURE IN SURGERY. 



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112 ON THE BLOOD-PRESSURE IN SURGERY. 



At 12.12, infusion completed. Blood-pressure rose gradually 
to the normal to no mm.; stroke, 21 mm. 

At 12.15, blood-pressure, 50 mm.; stroke, 15 mm. 

At 12.20, blood-pressure, 40 mm.; stroke, 11 mm.; pulse, 80. 

The blood-pressure gradually fell to 30 mm. ; ^/g^ 
grain of strychnin produced no change. A repetition 
was without effect. 

Experiments 88, 89, 90. 

Strychnin and Control Experiments. 

Dog I, control, mongrel; good condition; weight, 
fifteen kilos. 

Dog 2, strychnin, mongrel ; good condition ; weight, 
sixteen kilos. Ether anesthesia. 
Dog I, preliminary blood-pressure, 160 mm. ; stroke, 
10 mm. 

Dog 2, preliminary blood-pressure, 160 mm. ; stroke, 
12 mm. 

Both animals were reduced to shock by exposing and 
manipulating the intestines simultaneously, with an 
equal degree of severity. 

Dog I, blood-pressure, no mm.; stroke, 8 mm. 
Dog 2, blood-pressure, no mm.; stroke, 12 mm. 
Following this observation a slight rise in the blood- 
pressure occurred. 

Dog I, blood-pressure, 128 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 128 mm.; stroke, 15 mm. 
Dog 2 was injected with ^/i2o grain of strychnin. 
There was a very slight rise in the blood-pressure 
of the control animal and a fall in the experiment 
animal. 

Dog I, blood-pressure, 132 mm.; stroke, 10 mm. 
Dog 2, blood-pressure, 114 mm. ; stroke, 8 mm. 
After an interval of ten minutes the blood-pressure 
of dog I was no mm. ; stroke, 10 mm. 
Dog 2, blood-pressure, 104 mm. ; stroke, 4 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 113 

Dog 2, an injection of V120 grain of strychnin was 
given. 

Dog I, blood-pressure, 100 mm.; stroke, 5 mm. 
Dog 2, blood-pressure, 108 mm.; stroke, 7 mm. 
The injections were given at ten-minute intervals, 
and the observations prior to and immediately fol- 
lowing injections were recorded as follows : 
Dog I, blood-pressure, 94 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 102 mm. ; stroke, 7 mm. 
Dog 2 was injected with V120 grain of strychnin. 
Dog I, blood-pressure, 94 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 95 mm. ; stroke, 3 mm. 
Dog I, blood-pressure, 96 mm. ; stroke, 10 mm. 
Dog 2, blood-pressure, 94 mm. ; stroke, 4 mm. 
Dog 2 was injected with ^/i2o grain of strychnin. 
Dog I, blood-pressure, 96 mm.; stroke, 10 mm. 
Dog 2, blood-pressure, 102 mm.; stroke, 5 mm. 
Dog I, blood-pressure, 90 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 192 mm. ; stroke, 9 mm. 
Dog 2 was injected with ^/i2o grain of strychnin. 
Dog I, blood-pressure, 86 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 80 mm. ; stroke, 8 mm. 
Dog I, blood-pressure, 85 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 80 mm. ; stroke, 8 mm. 
Dog 2 was injected with ^/joq grain of strychnin. 
Dog I, blood-pressure, 76 mm. ; stroke, 6 mm. 
Dog 2, blood-pressure, 77 mm. ; stroke, 5 mm. 
Dog I, blood-pressure, 83 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 85 mm.; stroke, 5 mm. 
Dog 2 was injected with ^/i2o grain of strychnin. 
Dog I, blood-pressure, 82 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 80 mm. ; stroke, 9 mm. 
Dog I, blood-pressure, 108 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 85 mm. ; stroke, 8 mm. 
The rise in the blood-pressure of dog i was due to 
an uneven anesthesia. 

Dog 2 was injected with V120 grain of strychnin. 
8 



114 



ON THE BLOOD-PRESSURE IN SURGERY. 



Dog I, blood-pressure, loo mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 78 mm. ; stroke, 9 mm. 
Dog I, blood-pressure, 98 mm.; stroke, 8 mm. 
Dog 2, blood-pressure, 78 mm. ; stroke, 6 mm. 
Dog 2 was injected with V120 grain of strychnin. 
Dog I, blood-pressure, 100 mm.; stroke, 6 mm. 
Dog 2, blood-pressure, 50 mm. ; stroke, 3 mm. 
Dog 2 was injected with ^/i2o grain of strychnin. 
Dog I, blood-pressure, 100 mm. ; stroke, 6 mm. 
Dog 2, blood-pressure, 50 mm. ; stroke, 3 mm. 
Dog 2 was injected with ^/i2o grain of strychnin. 
Dog I, blood-pressure, 105 mm.; stroke, 7 mm. 
Dog 2, blood-pressure, 18 mm.; stroke, 2 mm. 
Dog I, blood-pressure, 98 mm.; stroke, 5 mm. 
Dog 2, blood-pressure, 5 mm. ; stroke, o mm. 
Dog 2, dead, having had no convulsion. 
Time of experiment, two and one-half hours. 
Dog I, blood-pressure, 96 mm.; stroke, 7 mm. 
The control dog was now injected, at intervals of 
ten minutes, with V20 grain of strychnin. 
Blood-pressure, 120 mm.; stroke, 4 mm. 
Blood-pressure, 125 mm.; stroke, 6 mm. 
Reflexes became heightened. 
Blood-pressure, 125 mm.; stroke, 6 mm. 
One-twentieth grain of strychnin was injected. 
Blood-pressure, 76 mm. ; stroke, 5 mm. The dog's 
respiration was gasping. 
Blood-pressure. 100 mm.; stroke, 3 mm. 
One-twentieth grain of strychnin was injected. 
Blood-pressure, 98 mm. ; stroke, 4 mm. The re- 
flexes were greatly heightened. 
Blood-pressure, 100 mm. ; stroke, 4 mm. 
One-twentieth grain of strychnin was injected. This 
was immediately followed by convulsions and death 
of the animal. 

Time of experiment three and one-half hours. 



ON THE BLOOD-PRESSURE IN SURGERY. 

Experiment 91. 

Strychnin, Whiskey, Digitalis. Shock and Collapse. 

Dog" ; female mongrel ; good condition ; weight, 
eighteen kilos. 

At I I.I o, initial blood-pressure, 120 mm.; pulse, 148; stroke, 
10 mm. Vagi and accelerantes were bloodlessly sev- 
ered. 

At 1 1.36.30, blood-pressure, 115 mm.; pulse, 128. The ad- 
ministration of I ounce of a .5 per cent, solution of 
curare was followed by a fall of blood-pressure to 
40 mm., evidently due to the too rapid administration 
of the drug. 

At 12.08, blood-pressure, 40 mm.; pulse, 128; stroke, 6 mm. 
At 12.09, stimulation of the sciatic nerve was followed by a 

rise of 20 mm. in the blood-pressure; later, by a 

gradual fall. 

At 12.10, 10 minims of tincture of digitalis were intravenously 
given. 

At 12.12, blood-pressure, 40 mm. ; pulse, 136; stroke, 10 mm. 
At 12. 14, blood-pressure, 35 mm.; pulse, 136; stroke, 10 mm. 

Fifty minims of whiskey were injected. 
At 12.15, blood-pressure gradually rose 16 mm.; pulse, 136. 
At 12.21, blood-pressure, 60 mm.; pulse, 124; stroke, 6 mm. 
At 12.22,^/30 grain of strychnin was injected. 
At 12.23, blood-pressure rose to 145 mm. 
At 12.26, blood-pressure, 130 mm. 

At 12.35, blood-pressure, 4^ nim. ; pulse, 140; stroke, 10 mm. 

Electrical stimulation of the sciatic nerve was fol- 
lowed by a slight rise. 

At 1. 01, an injection of ^/^o grain of strychnin was followed 
by a fall in the blood-pressure to 20 mm. 

At 1.02, artificial respiration was discontinued for half a min- 
ute. The pressure rose to 25 mm. 

At 1.04, blood-pressure, 25 mm.; stroke, 11 mm. 

At 1.05, V30 grain of strychnin was injected. 



I 



Il6 ON THE BLOOD-PRESSURE IN SURGERY. 



At 1.06, blood-pressure, 20 mm. Burning the paw caused no 
change in the blood-pressure. 

Artificial respiration was discontinued. The blood- 
pressure remained at 20 mm. 
At 1. 14, the animal died, the blood-pressure having remained 
constant at 20 mm. since the last observation. 

Experiment 92. « 

Strychnin, Nitroglycerin, and Cocain. 

Mongrel dog; good condition; weight, six kilos. 
Ether anesthesia. 

Blood-pressure cannula was adjusted in the carotid. 
The animal did not breathe well during the anes- 
thesia. One one-hundredth grain of strychnin was 
injected into the jugular vein. A very slight, gradual 
rise in the blood-pressure followed. 
Ten seconds later, ^/go grain of strychnin was in- 
jected into the jugular vein. The gradual rise con- 
tinued. 

Fifteen seconds later, ^/^q grain of nitroglycerin was 
given. A slight fall in the blood-pressure followed. 
The pulse-rate was diminished. The length of the 
strokes was markedly decreased. Artificial respi- 
ration became necessary. Convulsions followed. 
To test the effect of cocain upon the convulsions, 
^/lo grain was injected into the jugular vein. The 
convulsion persisted. A marked fall in the blood- 
pressure, with shortened strokes, followed. The 
heart and respiration ceased and the blood-pressure 
dropped to the abscissa line. The dog was supposed 
to be dead, and was skinned over the entire central 
surface and legs, in order to observe the blood dis- 
tribution in the superficial vessels. The abdomen was 
then opened by a three-inch incision. At this point 
the animal began to breathe, and the heart's action 
was resumed. Convulsions followed immediately, 



ON THE BLOOD-PRESSURE IN SURGERY. 117 

and the blood-pressure rose and fell, synchronous with 
the muscular contraction and relaxation. The dog 
was inverted head up, then head down. In the mean 
time artificial respiration was maintained. For a 
short time the heart beat only during inspiration. A 
few seconds later the heart began to beat indepen- 
dent of respiratory action, and the blood-pressure 
rose. The abdominal incision and the skin were 
then sutured together. Both vagi were severed al- 
most simultaneously, the heart beating slowly. Vio- 
lent convulsions appeared. The blood-pressure ex- 
cursions became slow and feeble. The animal died 
from respiratory failure. 

Experiment 93. 
Nitroglycerin, Strychnin, Saline Infusion, Cocain. 

Mongrel dog; good condition; weight, nine kilos. 
Ether anesthesia. 

Blood-pressure cannula was adjusted in the right 
carotid. An excess of anesthetic was given, the 
blood-pressure fell and respiration ceased. Artificial 
respiration was given. The dog was inverted head 
up, then brought to the horizontal posture, the blood- 
pressure rapidly regaining its normal level. 
One-thirtieth grain of strychnin was injected into 
the left jugular vein. A gradual, slight rise in the 
blood-pressure followed. 

One-thirtieth grain of strychnin was again injected. 
In forty-five seconds convulsions developed. After 
the convulsions subsided, pinching the foot caused a 
sharp rise in the blood-pressure, and the convulsion 
was renewed. This was repeated several times. 
The injection of ^/lo grain of nitroglycerin resulted 
in a fall of the blood-pressure, followed by a rapid 
rise to its former level. An injection of ^/go grain 
of nitroglycerin was followed by a similar phenome- 



ON THE BLOOD-PRESSURE IN SURGERY. 



non. One-thirtieth grain of strychnin, then ^/go 
grain, was injected ; a sHght rise in the blood-pressure 
ensued. The blood-pressure was well sustained for 
forty seconds. 

One-twelfth grain of nitroglycerin was given. A 
sharp fall in the blood-pressure followed and con- 
vulsions developed. The blood-pressure again re- 
covered. 

One-tenth grain of nitroglycerin was then adminis- 
tered without effect. 

Both vagi were next severed, following which there 
was some rise in the blood-pressure and failure of 
respiration. Artificial respiration was supplied. 
On injecting ^/g grain of nitroglycerin, the blood- 
pressure fell sharply, with slow recovery. The in- 
jection of ^/oQ grain of strychnin was followed by a 
gradual rise in the blood-pressure. The respiratory 
waves on the blood-pressure curves were increasingly 
marked. 

Forty ounces of normal saline solution were given, 
the blood-pressure rising and respiration improving. 
Convulsions appeared at intervals. 
One-fifth grain of cocain was injected, following 
which there occurred repeated convulsions and some 
rise in the blood-pressure. The animal died from 
respiratory failure. 

Experiment 94. 
Shock. 

Male dog; fair condition; weight, eight kilos. 
Initial blood-pressure, no mm. 

Vagi were severed. No change in the blood-pressure. 
Strokes became long and sweeping. The animal was 
then extensively burned. A fall in the blood-pressure 
to 50 mm. was noted. Respiration failed and the 
animal died. 



ON THE BLOOD-PRESSURE IN SURGERY. ng 

Experiment 95. 
Shock, Strychnin, Splanchnic Circulation. 

Dog ; male mongrel ; good condition ; weight, thir- 
teen kilos. 

At 2.30, initial blood-pressure, 120 mm.; stroke, 13 mm.; 

pulse, 126. The vagi and accelerantes were exposed 

by bloodless dissection and severed. 
At 2.45, blood-pressure, 130 mm.; stroke, 20 mm. ; pulse, 132. 

The integument was removed from three-fourths of 

the body and the denuded surface sponged. 
At 3.13, blood-pressure, 80 mm.; stroke, 14 mm.; pulse, 136. 
At 3.14, burning the hind paw caused an abrupt rise of 55 mm. 

in the blood-pressure, subsequently an equal fall. The 

denuded surfaces were then roughly sponged for a 

considerable time. 
At4. 10, blood-pressure, 58 mm.; stroke, 20 mm.; pulse, 128. 
At4.ii,4 drams of a .5 per cent, solution of curare were 

intravenously injected. Artificial respiration was 

supplied. 

At4. 17, electrical stimulation of the sciatic nerve produced no 
appreciable effect upon the blood-pressure. Blood- 
pressure, 20 mm.; stroke, 8 mm.; pulse, 130. 

At 4. 18, ■'/g grain of strychnin solution was intravenously in- 
jected. 

At 4.20, the injection was repeated. The blood-pressure gradu- 
ally rose. 

At 4.22, blood-pressure, 80 mm. ; stroke, 12 mm.; pulse, 128. 

At 5.02, blood-pressure, 55 mm. ; burning of the paw and elec- 
trical stimulation of the sciatic nerve produced a very 
slight rise in the blood-pressure. 

At 5.04, ^/go grain of strychnin was intravenously injected. 

No change in the blood-pressure was obtained. On 
opening the abdomen, the color of the intestines was 
found to be normal. The injection of 1.5 drams of 
tincture of digitalis produced no change upon the 



I20 ON THE BLOOD-PRESSURE IN SURGERY. 

blood-pressure or in the pulse-rate. The blood-pregs- 
ure continued at 30 mm. 
At 5.17, the animal died. 

Experiment 96. 

Shock, Strychnin, and Bandaging. 

Dog; male mongrel; fair condition; weight, twelve 
kilos. 

At 8.42, initial blood-pressure, 140 mm.; stroke, 12 ram.; 
pulse, 196. 

At 8.47, stimulation of the sciatic nerve was followed by a 
sharp fall of 18 mm. in the blood-pressure, and later 
by a rise to its former level. Both vagi and accele- 
rantes were severed. 

At 9.09, blood-pressure, 140 mm.; pulse, 148. 

At 9.10, respiration failed. Artificial respiration was main- 
tained for forty minutes. Normal respiration was 
not resumed. 

At 10.00, burning a hind paw produced a rise in the blood- 
pressure to 60 mm. The animal was then skinned 
and the denuded surface sponged. 

At 10.32, blood-pressure, 30 mm.; pulse, 116. 

At 10.33,9.5 drams of a .5 per cent, solution of curare were 
intravenously injected. 

At 10.43.30, blood-pressure, 25 mm. ; stroke, 7 mm. ; pulse, 
112. 

At 10.44, ^Ao grain of strychnin was intravenously injected. 

The blood-pressure rose to 25 mm. ; stroke, 7 mm. ; 

pulse, no. Within fifteen minutes after the injection 

the pressure had again fallen to 20 mm. Burning 

the paw produced no effect upon the blood-pressure. 
At 11.03,^/12 grain of strychnin was intravenously injected. 

No rise in the blood-pressure occurred. 
At 11.05, the animal was bandaged, causing the blood-pressure 

to rise to 40 mm., at which level it was maintained. 
At 11.29, the dog died, the blood-pressure being 45 mm. The 

intestines were not exposed until the moment of 



ON THE BLOOD-PRESSURE IN SURGERY. 121 

death, when they were inspected and found to be 
pale. There was no evidence of an accumulation of 
blood in the splanchnic area. 



EXPEKIMENT 97. 

Shock, Curare, and Strychnin. 

Dog; female mongrel ; good condition; weight, fif- 
teen kilos. Ether anesthesia. 
Tracheal and carotid cannula were adjusted. 
At 9.50, initial blood-pressure, 125 mm.; stroke, 10 mm.; 
pulse, 122. 

At 9.55, both vagi and accelerantes were severed. Blood- 
pressure, 55 mm.; stroke, 15 mm.; pulse, 130. 
Shock was produced by removal of the integument, 
manipulation of the intestines, and crtishing the paws. 

At 10.27, the intestines were returned to the abdomen and the 
wound was closed. 

At 10.32, blood-pressure, 50 mm. ; stroke, 12 mm.; pulse, 136. 

From 10.32 to 10.43, 5-5 drams of a .5 per cent, solution of 
curare were injected into the femoral vein. During 
this time the blood-pressure gradually rose to 60 mm. 

At 10.44, ^/go grain of strychnin was injected into the fem- 
oral vein. The blood-pressure rose to 155 mm.; 
stroke, 14; pulse, 124. The blood-pressure curve 
continued at about this height for a little more than 
an hour. The curve exhibited a considerable number 
of waves entirely independent of the respiratory ef- 
fects. These waves increased towards the end of the 
hour. 

At 12.28, blood-pressure, 140 mm.; stroke, 10 mm.; pulse, 
120. A gradual decline in the blood-pressure now 
began, but the pulse and the strokes remained con- 
stant. 

At 12.45, blood-pressure, 120 mm. ; the curve was very irregu- 
lar. 

At 1. 14, blood-pressure, 110 mm. 



122 ON THE BLOOD-PRESSURE IN SURGERY. 

At 2.30, blood-pressure, 90 mm.; stroke, 10 mm.; pulse, 100. 

At 2.31, the sciatic nerve was electrically stimulated. An ab- 
rupt rise of 40 mm. followed, but an equal fall was 
noted. 

At 2.34, ^/ao grain of strychnin was injected into the fem- 
oral vein. An abrupt rise in the blood-pressure to 
175 mm. was noted; stroke, 15 mm. ; pulse, 96. The 
marked undulations in the blood-pressure curve again 
appeared. When the blood-pressure was at its maxi- 
mum height the sciatic nerve was electrically stimu- 
lated, resulting in a rise of 30 mm. in the blood- 
pressure, followed by an equal fall. 

At 2.49, ^/so grain of strychnin was injected into the fem- 
oral vein. This was followed by a rise of 20 mm. ; 
later, by an abrupt fall to the former level. 

At 2.50.30, ■'/go grain of strychnin was again injected, after 
which a similar rise and fall in the blood-pressure was 
observed. 

At 2.53, blood-pressure, no mm.; stroke, 18 mm.; pulse, 80. 

At 2.54, ^/ao grain of strychnin was injected into the fem- 
oral vein. A sharp fall of 40 mm. in the blood- 
pressure occurred. 

At 2.57, blood-pressure, 150 mm.; stroke, 12 mm.; pulse, 80. 

At 2.57.30, ^/go grain of strychnin was again injected. A 
slight fall in the blood-pressure followed. The sci- 
atic nerve was electrically stimulated, the blood- 
pressure rising 10 mm. 

At 3.05, blood-pressure, 60 mm. The sciatic nerve was stimu- 
lated, but no appreciable effect followed. The 
splanchnic nerves were then electrically stimulated. 
A slight rise in the blood-pressure followed, after 
which the pressure rapidly fell. 

At 3. 1 1, the animal died. 



ON THE BLOOD-PRESSURE IN SURGERY. 123 

EXPEKIMENT 98. 

Shock, Curare, Strychnin. 

Dog ; male mongrel ; weight, nine kilos. Ether anes- 
thesia. 

Blood-pressure, 145 mm.; pulse, 120; stroke, 10 mm. 

At 9.57, both vagi and accelerantes were severed. Blood- 
pressure, 125 mm.; pulse, 120; stroke, 15 mm. Res- 
piration was greatly slowed and deepened. The 
animal was reduced to surgical shock by intestinal 
manipulation and crushing the paws. 

At 10.19, blood-pressure, 80 mm.; pulse, 120; stroke, 10 mm. 

At 10.23, 3 drams of a .5 per cent, solution of curare were 
injected. 

At 1 1.27, blood-pressure, 30 mm.; pulse, 120; stroke, 10 mm. 

At 1 1.35, •'/64 grain of strychnin was injected. 

At 1 1.36, blood-pressure, 60 mm. ; pulse, 120; stroke, 18 mm. 

At 1 1.38.30, blood-pressure, 75 mm.; pulse, 120; stroke, 11 
mm. The blood-pressure curve exhibited great ir- 
regularity. The rise in the blood-pressure following 
the injection of strychnin continued forty-five min- 
utes. The maximum rise, five minutes. 

At 12.34, blood-pressure, 40 mm. ; pulse, 88; stroke, 7 mm. 

At 12.35, Voo grain of strychnin was injected. 

At 12.36, blood-pressure, 80 mm.; pulse, 98 mm.; stroke, 10 
mm. The waves now measured about 15 mm. 

At 12.58, blood-pressure, 25 mm.; pulse, 100; stroke, 10 mm. 

The effect of the second dose continued for twenty- 
five minutes. 

At 1. 00, blood-pressure, 45 mm. ; pulse, 100; stroke, 10 mm. 

At 1.01,^/120 grain of strychnin was administered. No effect 
upon the blood-pressure was obtained. 

At 1.03,^/120 grain of strychnin was injected without effect. 

At 1. 09, a slow decline began. Repeated injections of ^/qo 
grain of strychnin were given at one-minute intervals, 
the blood-pressure gradually declining. 

At 1. 19, blood-pressure, 15 mm.; pulse, 84. Curve irregular. 

At 1.2 1, the dog died. 



124 ™^ BLOOD-PRESSURE IN SURGERY. 

Experiment 99. 

Shock, Strychnin, Curare. 

Dog; male mongrel; good condition; weight, 
twenty-two kilos. 

The tracheal carotid and femoral cannulas were ad- 
justed. Preliminary observations were then made. 

At 2.45, blood-pressure, 130 mm.; pulse, 180. 

At 2.50, the sciatic nerve was electrically stimulated. This was 
followed by an abrupt rise and fall in the blood- 
pressure. 

At 3. 12, 10.5 ounces of a .5 per cent, solution of curare were 
injected into the femoral vein. 

At 3.50, the sciatic nerve was electrically stimulated, following 
which an abrupt rise in the blood-pressure occurred. 
The intestines were exposed and manipulated. 
Blood-pressure, 98 mm.; pulse, 156. 

At 3.54, blood-pressure, 158 mm.; pulse, 107. 

At 3.54.30, ^/g4 grain of strychnin was injected into the fem- 
oral vein. 

At 3.55.30, blood-pressure, 155 mm.; pulse, 196. 

At 3.59.30, blood-pressure, 140 mm.; pulse, 180. 

At 4.01, the sciatic nerve was electrically stimulated. This was 
followed by an abrupt rise and fall in the blood- 
pressure. 

At 4.03, blood-pressure, 142 mm.; pulse, 148. 
At 4.04, ^/64 grain of strychnin was injected into the femoral 
vein. 

At 4.07, blood-pressure, 157 mm.; pulse, 192. 

At 4.07.30, the sciatic nerve was electrically stimulated, causing 
an abrupt rise and fall in the blood-pressure. 

At 4. 14, blood-pressure, 140 mm.; pulse, 180. 

At 4. 15,^/64 grain of strychnin was injected into the femoral 
vein, causing an abrupt rise in the blood-pressure, 
reaching a maximum of 160 mm. 

At 4. 1 7, the sciatic nerve was electrically stimulated. This was 
followed by an abrupt rise and fall in the blood- 
pressure. 



ON THE BLOOD-PRESSURE IN SURGERY. 125 

At 4.25, blood-pressure, 140 mm.; pulse, 192. 

At 4.32.30, blood-pressure, 125 mm.; pulse, 176. 

At 4.33, ^/e4 grain of strychnin was injected into the femoral 

vein, causing a rise. Blood-pressure, 160 mm. ; pulse, 

204. 

At 4.38.30, blood-pressure, 156 mm.; pulse, 200. 

At 4.39, the sciatic nerve was stimulated. An abrupt rise, fol- 
lowed by a fall, was observed in the blood-pressure. 

At 4.44, blood-pressure, no mm.; pulse, 198. 

At 4.44.30, ■'/64 grain of strychnin was injected into the fem- 
oral vein. 

At 4.46.30, blood-pressure, 165 mm.; pulse, 180. 

The animal was under observation until 5.48. 

At 5.48, blood-pressure, 135 mm.; pulse, 184. 

At 5.52, the sciatic nerve was electrically stimulated. An ab- 
rupt rise and fall in the blood-pressure followed. 

At 5.54, blood-pressure, 140 mm.; pulse, 182. 

At 5.54.30, ■^/64 grain of strychnin was injected into the fem- 
oral vein. 

At 5.55.30, blood-pressure, 163 mm.; pulse, 180. 

At 6.03, blood-pressure, 165 mm.; pulse, 188. 

At 6.14, the sciatic nerve was electrically stimulated. An ab- 
rupt rise and fall in the blood-pressure was noted. 

At 6.15, blood-pressure, 140 mm.; pulse, 160. 

At 6. 15.15, ^/64 grain of strychnin was injected into the fem- 
oral vein. 

At 6.16, blood-pressure, 165 mm.; pulse, 176. 

At 6. 19, the sciatic nerve was electrically stimulated, following 

which there occurred an abrupt rise and fall in the 

blood-pressure. 
At 6.21, blood-pressure, 155 mm.; pulse, 176. 
At 6.23,^/64 grain of strychnin was injected into the femoral 

vein. 

At 6.24, blood-pressure, 160 mm. ; pulse, 184. 

At 6.52, blood-pressure, 150 mm.; pulse, 180. 

At 6.53.45, the sciatic nerve was electrically stimulated. An 
abrupt rise and fall in the blood-pressure was ob- 
tained. 



126 ON THE BLOOD-PRESSURE IN SURGERY. 



At 6.54, blood-pressure, 135 mm.; pulse, 178. 
At 6.54.30, V64 grain of strychnin was injected into the fem- 
oral vein. 

At 6.55.15, blood-pressure, 156 mm.; pulse, 176. 

At 7.01, blood-pressure, 150 mm.; pulse, 160. 

At 7.01. 15, V20 grain of strychnin was injected. 

At 7.02, blood-pressure, 160 mm. ; pulse, 176. 

At 7.05, the sciatic nerve was electrically stimulated. This was 
followed by an abrupt rise and fall in the blood- 
pressure. 

At 7.25, blood-pressure, no mm.; pulse, 140. 

At 7.45, blood-pressure, 60 mm.; pulse, 136. 

At 8. 1 5, blood-pressure, 40 mm.; pulse, 150. 

At 8.30, blood-pressure, 40 mm. ; pulse, 148. The animal was 

killed by allowing MgS04 to flow into the femoral 

vein. 

Experiment 100. 

Strychnin and Curare. 

Male mongrel ; good condition ; weight, eleven kilos. 
Ether anesthesia. 

Tracheal and carotid cannulae were applied, and ex- 
posure of both femoral veins was made. 

At 10.35, preliminary blood-pressure, no mm.; stroke, 10 
mm.; pulse, 100. A cannula was introduced into 
the femoral vein, and attached to a burette contain- 
ing a .5 per cent, solution of curare. 

At 10.45, s^^"" injection of 3.33 ounces of curare was adminis- 
tered at the rate of 2.6 drams per ten minutes. A 
primary fall, then a rise, followed by a secondary fall 
in the blood-pressure, were noted. 

At 12.20, blood-pressure, 50 mm.; stroke, 4 mm.; pulse, 144. 

At 12.25, the injection of Vio grain of strychnin was made 
into the opposite femoral veins. This was followed 
by a sharp rise in the blood-pressure, an increase in 
the length of stroke, and an increase in the pulse-rate. 

At 12.28, blood-pressure, 165 mm.; stroke, 20 mm.; pulse, 
228. 



ON THE BLOOD-PRESSURE IN SURGERY. 127 

At 12.29, blood-pressure, mm.; stroke, 20 mm.; pulse, 
204. 

At 12.30, blood-pressure, 160 mm.; stroke, 20 mm.; pulse, 
205. 

At 12.39, blood-pressure, 160 mm.; stroke, 22 mm.; pulse, 
180. 

At 12.55, both vagi were severed. This was followed by a fall 

in the blood-pressure. Blood-pressure, 144 mm.; 

stroke, 20 mm. ; pulse, 180. 
At 1.05, an injection of 2.6 drams of a .5 per cent, solution 

of curare was made into the femoral vein. 
At 1. 18, blood-pressure, 38 mm.; stroke, 4 mm.; pulse, 108. 
At 1.22, an injection of Vio grain of strychnin was made into 

the femoral vein. This was followed by a primary 

rise in the blood-pressure, which now recorded 50 

mm.; stroke, 6 mm.; pulse, 108. 
At 1. 3 1, blood-pressure, 30 mm.; stroke, 4 mm.; pulse, 108. 

The sciatic was stimulated electrically without effect. 

The injection of ^/k, grain of strychnin produced no 

effect upon the blood-pressure. The pulse remained 

constant at 112. 
At 1.57, blood-pressure, 20 mm.; stroke, 5 mm.; pulse, 112. 

The sciatic was electrically stimulated without effect. 

The animal was killed by allowing MgS04 to flow 

into the carotid cannula. 

Experiment 101. 

Strychnin and Curare. 

Male mongrel dog; good condition; weight, nine 
kilos. Ether anesthesia. 

The tracheal carotid and femoral cannulse were ad- 
justed. 

Preliminary observations were as follows : 
At 2.27, blood-pressure, 108 mm.; pulse, 120. The vagi and 

accelerantes were severed. 
At 2.34, blood-pressure, 95 mm.; pulse, 144. 



128 ON THE BLOOD-PRESSURE IN SURGERY. 



At. 2. 37, the sciatic was stimulated electrically, a sharp rise 
in the blood-pressure following. 

At 2.40, 10 c.c. of a .5 per cent, solution of curare were in- 
jected into the femoral vein. This resulted in a 
regular blood-pressure. 

At 2.42, artificial respiration was supplied. 

At 2.45, the above injection was repeated, producing similar 
results. Electrodes were applied to the muscles and 
the sciatic nerves were stimulated, no muscular re- 
action being observed. Immediately following stimu- 
lation, there was a sharp rise in the blood-pressure, 
with a corresponding fall. 

At 3.02, blood-pressure, 115 mm.; pulse, 148. One-sixty- 
fourth grain of strychnin was then injected into the 
femoral vein. After a period of two minutes there 
was a sharp rise in the blood-pressure to 130 mm., 
and an increase of 40 in the pulse-rate. 

At 3.10, blood-pressure, 155 mm.; pulse, 188. 

At3.i2, ■^/64 grain of strychnin was injected into the femoral 
vein. One minute later the blood-pressure recorded 
255 mm.; pulse, 208. 

At 3.20, blood-pressure, 155 mm.; pulse, 204. 

At 3.25.30, V64 grain of strychnin was injected into the fem- 
oral vein. 

At 3.27, blood-pressure, 200 mm. ; pulse, 212. 
At 3.46, blood-pressure, 160 mm. ; pulse, 212. 
At 4. 13.30, blood-pressure, 50 mm.; pulse, 160, very irregular. 
At 4. 14, ^/64 grain of strychnin was injected into the femoral 
vein. 

At 4.18, blood-pressure, 150 mm.; pulse, 200. 

At4. 19, the sciatic was stimulated electrically, producing a 

very irregular blood-pressure. 
At 4.42, blood-pressure, 150 mm.; pulse, 176. The animal was 

killed by allowing MgS04 to flow into the carotid 

cannula. No convulsions were in evidence during 

this experiment. 



ON THE BLOOD-PRESSURE IX SURGERY. 



Experiment 102. 

Shock, Strychnin. 

Dog ; mongrel male ; good condition ; weight, eleven 
kilos. Ether anesthesia. 

Normal pressure, 140 mm.; pulse, 160; stroke. 15 
mm. 

Both vagi and accelerantes were bloodlessly severed. 
The blood-pressure fell 5 mm. during the operation. 
The pulse decreased from 160 to 120. The animal 
was then reduced to surgical shock by intestinal ma- 
nipulation, removal of one-fourth of the integument, 
and crushing the paws. 

Blood-pressure. 40 mm.; pulse, 118: stroke, 8 mm. 
The injection of 6.6 drams of a .5 per cent, solution 
of curare was made. 

Blood-pressure, 35 mm.: pulse, 116: stroke. 7 mm. 
One-tenth grain of strychnin was injected into the 
femoral vein. 

At the expiration of one minute and a half the blood- 
pressure rose to 85 mm., then gradually fell to 60 
mm., at which level it was maintained for fifteen 
minutes. A repetition of the foregoing injection was 
followed by a fall, which continued until death. 

EXPEEIMEXT 103. 

Strychnin and Curare. 

Dog; male mongrel; excellent condition; weight, 
ten kilos. Ether anesthesia. 

The tracheal carotid and femoral cannulae were ad- 
justed. Preliminary observations were then made. 
At 10.30, blood-pressure, 130 mm.; stroke. 12 mm.; pulse, 
152. The vagi and accelerantes were then divided. 
This caused a slight fall in the blood-pressure, fol- 
lowed by recovery. The respirations were of the 
vagal type. 

9 



i 



130 ON THE BLOOD-PRESSURE IN SURGERY. 

At 10.40, blood-pressure, 125 mm.; stroke, 16 mm.; pulse, 
120. An injection of 10.6 drams of a .5 per cent, 
solution of curare was then given into the femoral 
vein. Artificial respiration was then supplied. 

At 1 1. 1 1, blood-pressure, 130 mm.; stroke, 10 mm.; pulse, 
108. 

At I I.I I.I 5, ^/g4 grain of strychnin was injected into the fem- 
oral vein, having no effect on the blood-pressure. 

At 1 1. 1 2. 30, the above injection was repeated. This was fol- 
lowed by a rise of 10 mm. in the blood-pressure. 

At 1 1. 14, a repetition of the foregoing produced no effect. 

At 1 1. 16, there was a rise of 100 mm. in the blood-pressure, 
followed by long sweeping strokes 80 mm. in length. 
A fall in the blood-pressure, which subsequently re- 
mained constant at 203 mm., occurred. 

At 1 1.20, Vio grain of strychnin was injected into the fem- 
oral vein. This was followed by an irregular rise 
and fall in the blood-pressure, which recorded 200 
mm. From 11.47 to 12.54 the blood-pressvire was 
very irregular, during which time there was a gradual 
fall. 

At 12.57, blood-pressure. 70 mm.; pulse, 108. 
At 2.01, blood-pressure, 45 mm. The animal was killed with 
MgSO,. 

From 1. 2 1 to 2.01 the intestines were exposed and 
manipulated. This produced an alternate rise and 
fall in the blood-pressure. Convulsions were not in 
evidence during the experiment. 

Experiment 104. 

Shock, Strychnin, and Saline Infusion. 

Dog; male mongrel; good condition ; weight, eleven 
kilos. 

At 1 1.09, initial blood-pressure, 125 mm.; pulse, 176; stroke, 
9 mm. Both vagi and accelerantes were severed. 



ON THE BLOOD-PRESSURE IN SURGERY. 131 

At 1 1.26, blood-pressure, 120 mm.; pulse, 124; stroke, 15 mm. 

The animal was reduced to surgical shock by re- 
moving the integument and mechanically irritating 
the raw surface. 

At 1 1.36, blood-pressure, 90 mm.; pulse, 120; stroke, 20 mm. 

One ounce of a .5 per cent, solution of curare was 
administered. 

At 1 1.57, blood-pressure, 40 mm. ; pulse, 120. 

At 11.58, electrical stimulation of the sciatic was followed by a 
rise of 20 mm. in the blood-pressure. 

At 12.02, blood-pressure, 40 mm.; pulse, 120; stroke, 11 mm. 

At 12.02.30, ^/so grain of strychnin was injected. 

At 12.03.30, blood-pressure, 155 mm.; pulse, 116; stroke, 
13 mm. 

At 12.13, blood-pressure, 140mm.; pulse, 120; stroke, 15 mm. 
At 12.22, blood-pressure, 130 mm.; pulse, 120; stroke, 13 mm. 
At 12.33, blood-pressure, ii8mm. ; pulse, 116; stroke, 13 mm. 
At 12.33.30, blood-pressure, 130 mm.; pulse, 120; stroke, 
13 mm. 

At 12.35, blood-pressure, 94 mm. 

At 12.44, blood-pressure, 70 mm.; pulse, 116. 

At 12.48, blood-pressure, 55 mm.; pulse, 118. Stimulation of 
the sciaitic nerve was followed by a rise of 10 mm. ; 
lat^r, by a corresponding fall. 

At 12.51, blood-pressure, 51 mm.; stroke, 8 mm. 

At 12.51.30, V30 grain of strychnin was injected. The blood- 
pressure rose sharply to 120 mm. 

At 12.58, blood-pressure, 100 mm. ; pulse, 108. 

At 1.02, blood-pressure, 70 mm.; pulse, 120. 

At 1.09, blood-pressure, 40 mm. 

At 1. 12, blood-pressure, 35 mm. Electrically stimulating the 
sciatic nerve caused a rise of 5 mm. in the blood- 
pressure, which was followed by an equal fall. 

At 1.13,^/30 grain of strychnin was injected. Some irregu- 
larity, showing a decline in the blood-pressure, fol- 
lowed. 

At 1. 18, blood-pressure, 20 mm. 



/ 



132 ON THE BLOOD-PRESSURE IN SURGERY. 

At 1. 27, the infusion of normal saline was inaugxirated. A 
gradual rise in the blood-pressure, varying with the 
rate of flow, was obtained. 

During thirteen minutes, ;^2>-33 ounces were adminis- 
tered. 

Blood-pressure, iiomm. ; stroke, 16 mm. 

Twenty minutes later, blood-pressure recorded 80 

mm.; pulse, 120; stroke, 14mm. 

Fifteen minutes later, blood-pressure, 55 mm. ; pulse, 

120. 

Ten minutes later blood-pressure, 30 mm. 
At 2.40, the animal died. At autopsy, fluid was found in the 
pleural, pericardial, and peritoneal cavities. 

Experiment 105. 
Shock, Strychnin, Adrenalin. 

Dog; male mongrel; weight six kilos. 
An injection of Vseo grain of strychnin was given 
every two minutes until five doses had been admin- 
istered. A rise of 28 mm. in the blood-pressure was 
recorded. 

Four drams of curare in a .5 per cent, solution were 
given. 

An injection of ^/g grain of strychnin in fractional 
doses was given. A rise in the blood-pressure of 
74 mm. followed. 

The dog was reduced to shock by removing the in- 
tegument and sponging the raw surfaces. 
Twelve minims of a i to 1000 solution of adrenalin 
was followed by an abrupt rise in the blood-pressure 
to 50 mm. Repeated doses of adrenalin were given 
without effect. Later a continuous injection of a 
I to 100,000 solution of adrenalin maintained an even 
blood-pressure for more than one hour. The animal 
was killed. 



ON THE BLOOD-PRESSURE IN SURGERY. 133 

Experiment 106. 
Shock, Strychnin, Adrenalin. 

Dog ; male mongrel ; good condition ; weight, seven 
kilos. 

At 9. 14, initial blood-pressure, 140 mm.; pulse, 156; stroke, 
15 mm. The animal was reduced to shock by re- 
moval of the integument and irritation of the denuded 
surface. Tracings were taken at intervals, showing 
a gradual decline in the blood-pressure. The accele- 
rantes and vagi were severed while the animal was 
in but a slight degree of shock. 

At 10.55, blood-pressure, 3° mm.; stroke, 10 mm. 2.6 drams 
of a .5 per cent, solution of curare were injected into 
the femoral vein. Blood-pressure, 20 mm. ; stroke, 
8 mm. A gradual recovery to the former level oc- 
curred. Neither burning nor stimulating the sciatic 
produced a change in the blood-pressure. 2.6 drams 
of curare were injected into the femoral vein. Blood- 
pressure, 15 mm. 

At 1 1. 4 1, blood-pressure, 15 mm.; stroke, 8 mm. One-thirty- 
third grain of strychnin was administered intrave- 
nously. 

At 1 1.42, blood-pressure, 65 mm.; stroke, 12 mm. 

At 1 1.48, blood-pressure, 45 mm.; stroke, 14 mm. 

At 11.49, V30 grain of strychnin was administered. 

At 1 1.50, blood-pressure, 50 mm.; stroke, 14 mm. 

At 11.51,^/30 grain of strychnin was given. A slight fall in 
the blood-pressure was recorded. 

At 11.52,^/30 grain of strychnin was administered; blood- 
pressure, 44 mm. 

At 12.00,^/30 grain of strychnin was given; blood-pressure 
20 mm. Burning of the paw and electrical stimu- 
lation of the sciatic produced no change. 

At 12.34,^/30 grain of strychnin was injected. No effect was 
observed. 



134 ON THE BLOOD-PRESSURE IN SURGERY. 



At 12.36, V3 Q grain of adrenalin was given ; blood-pressure, 
95 mm. ; stroke, 60 mm. The blood-pressure fell. 
The animal died. 

Experiment 107. 
Shock, Strychnin, Vagi, Adrenalin. 

Dog; fair condition ; weight, eight kilos. Ether an- 
esthesia. 

At 1 1.56, blood-pressure, 120 mm.; pulse, 212. The animal 
was reduced to shock by skinning and then irritating 
the denuded surfaces. 

At 12.18, blood-pressure, 45 mm.; pulse, 132. 

At 2.27, on burning the paws the blood-pressm"e rose to 30 
mm.; pulse, 124. 

At 2.35, blood-pressure, 40 mm.; pulse, 124. One-thirtieth 
grain of strychnin was given, which produced con- 
vulsions. The convulsion caused a rise of 10 mm. 
in the blood-pressure. Respiration failed. Curare 
was administered and artificial respiration supplied. 
Burning the paw and electrically stimulating the sci- 
atic produced no effect upon the blood-pressure. Me- 
chanical stimulation of the larynx caused a reflex 
inhibition of the heart. 

At 2.50, both vagi were severed; blood-pressure, 40 mm.; 
pulse, 132. 

At 3.03, blood-pressure, 35 mm.; pulse, 132. On injecting 
2.6 drams of a i to 1000 solution of adrenalin, the 
blood-pressure rose to 105 mm., with no change in 
the pulse-rate. The animal was then killed. 

Experiments 108, 109, 110. 

Strychnin, Whiskey, and Bandaging. 

Dog I, good condition; weight, fifteen kilos. 
Dog 2, fair condition ; weight, eleven kilos. 
Dog 3, splendid condition; weight, sixteen kilos. 



ON THE BLOOD-PRESSURE IN SURGERY. 

At 1 1.20, the dogs were reduced to surgical anesthesia and 

prepared for the experiment. 
At 12.10, prehminary observation: 

Dog I, blood-pressure, 112 mm.; stroke, 20 mm.; 

pulse, 118; respiration, 56. 

Dog 2, blood-pressure, 140 mm.; stroke, 16 mm.; 
pulse, 152; respiration, 68. 

Dog 3, blood-pressure, 120 mm.; stroke, 25 mm.; 
pulse, 160; respiration, 52. 
At 12.25, the femoral veins were exposed. 

At 12.35, the intestines of all the animals were exposed and 
manipulated, with results as follows : 
Dog I, blood-pressure, 66 mm.; stroke, 6 mm.; 
pulse, 152; respiration, 40. 

Dog 2, blood-pressure, 120 mm.; stroke, 10 mm. 
pulse, 160; respiration, 60. 

Dog 3, blood-pressure, 100 mm.; stroke, 16 mm.; 

pulse, 160; respiration, 148. 
At 1. 01, the sciatic nerves of each animal were mechanically 

stimulated, with the results as follows : 

Dog, I, a rise of 10 mm. 

Dog 2, a rise of 16 mm. 

Dog 3, a rise of 20 mm. 
At 1.03, on burning the hind foot of each animal, the following 

changes in the blood-pressure were noted : 

Dog I, a rise of 5 mm. 

Dog 2, a rise of 40 mm. 

Dog 3, a rise of 15 mm. 
At 1.20, dog I, pulse, 148. 

Dog 2, pulse, 148. 

Dog 3, pulse, 130. 

The respiration of dog i was 56; dog 2, 148; dog 
3> 130. 

At 1.25, a clot formed in the cannula of dog 2, owing to over- 
anesthesia ; respiration failed, but recovered when 
artificial respiration was supplied. 

At 1.45, dog I, blood-pressure, 78 mm. ; stroke, 8 mm. ; pulse, 
160; respiration, 60. 



136 ON THE BLOOD-PRESSURE IN SURGERY. 



Dog 2, blood-pressure, 98 mm. ; stroke, 4 mm. ; pulse, 
168; respiration, 46. 

Dog 3, blood-pressure, 92 mm.; stroke, 15 mm.; 

pulse, 160; respiration, 40. 
At 1.59, dog I, Vso grain of strychnin in solution, 22 minims 

of normal saline were injected into the femoral vein. 
At 2.02, dog 2, the extremities, lower abdomen, and head were 

bandaged. 

Dog 3, 22 minims of whiskey were injected into the 

femoral vein. The results were as follows : 

Dog I, no change occvirred. 

Dog 2, the blood-pressure rose 15 mm. 

Dog 3, no change occurred in the blood-pressure. 

The pulse decreased twelve beats. 
At 2.26, dog I, a rise of 10 mm. occurred. 

Dog 2, the blood-pressure remained constant. 

Dog 3, a slight fall occurred. 
At 2.57, dog I, V30 grain of strychnin was injected into the 

femoral vein. 

Dog 2, no change in treatment. 

Dog 3, 22 minims of whiskey were given intrave- 
nously. 

Dog 3, a slight fall in the blood-pressure occurred. 
Dog I, a fall of 10 mm. in the blood-pressure oc- 
curred. 

At 3.15, burning the hind foot of each animal was followed 
by a rise in the blood-pressure. 

At 3.20, dog I, V30 grain of strychnin was given intravenously. 
Dog I, a slight rise in the blood-pressure resulted. 
Dog 3, 22 minims of whiskey were administered in- 
travenously; the blood-pressure fell slightly. 
From 3.20 to 4 the intestines of all the animals were 
manipulated. 

At 4.04, dog I, or the strychnin experiment, died. 

Dog 3, or the whiskey experiment, respiration ceased. 
Artificial respiration was supplied, and the abdomen 
and head were bandaged. Blood-pressure rose to 50 



ON THE BLOOD-PRESSURE IN SURGERY. 137 

mm., and the animal continued to live thirty minutes. 
Dog 2, or the bandage experiment, remained about 
the same. The bandage was removed, and an abrupt 
fall in the blood-pressure resulted. The animal died. 

Experiments 111, 112, 113. 

Strychnin, Digitalis, and Bandaging. 

Dog I, old mongrel; good condition ; weight, twenty- 
four kilos. 

Dog 2, hound ; good condition ; weight, twenty-three 
kilos. 

Dog 3, bull; fair condition, very fat; weight, eigh- 
teen kilos. 

Ether anesthesia. Tracheal and carotid cannulas were 
applied as nearly simultaneously as possible. 
Preliminary observation showed the following: 
At 1 1.23, dog I, blood-pressure, 170 mm.; pulse, 164; respi- 
ration, 80; stroke, 10 mm. 

Dog 2, blood-pressure, 120 mm.; pulse, 164; respi- 
ration, 148; stroke, 4 mm. 

Dog 3, blood-pressure, 170 mm.; pulse, 168; respi- 
ration, 176; stroke, 12 mm. 

At 11.54, the animals were simultaneously reduced to shock by 
exposing and manipulating the intestines. The fem- 
oral vein of each was exposed. 

Ati2.li,dog I, blood-pressure, 108 mm.; pulse, 152; respi- 
ration, 80; stroke, 10 mm. 

At 12.15, the hind paw of each dog was burned, and the fol- 
lowing changes were noted. 

Dog I, a rise of 6 mm. in the blood-pressure was fol- 
lowed by a secondary rise of 10 mm. ; respiration 
and pulse were increased and the stroke lengthened. 
Dog 2, a rise in the blood-pressure of 15 mm. oc- 
curred. Both the respiration and pulse were slightly 
decreased. 

Dog 3, a rise of 6 mm. in the blood-pressure occurred. 



ON THE BLOOD-PRESSURE IN SURGERY. 




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ON THE BLOOD-PRESSURE IN SURGERY. 139 

Dog I, blood-pressure, 98 mm.; pulse, 164; respi- 
ration, 90; stroke, 77 mm. 

Dog 2, blood-pressure, 55 mm.; pulse, 176; respi- 
ration, 70; stroke, 8 mm. 

Dog 3, blood-pressure, 88 mm.; pulse, 152; respi- 
ration, 80; stroke, 10 mm. 

Dog I retained fifty-eight per cent, of its original 
blood-pressure. 

Dog 2 retained forty-six per cent, of its original 
blood-pressure. 

Dog 3 retained fifty per cent, of its original blood- 
pressure. 

During the following ten minutes dog i lost 10 mm. 
in blood-pressure. 

Dog 2 lost 8 mm. in blood-pressure. 
Dog 3 lost 9 mm. in blood-pressure. 
At 12.26, dog 3 was bandaged. 

At 12.35, dog I was given ^/go grain of strychnin into the 
femoral vein. 

At 12.36, dog 2 was given 35 minims of tincture of digitalis 
into the femoral vein. 

At 12.37.30, the following observations were made: 

Dog I, blood-pressure, 106 mm.; pulse, 160; respi- 
ration, 168; stroke, 8 mm. The absolute rise was 
8 mm. 

Dog 2, blood-pressure, 60 mm.; pulse, 184; respi- 
ration, 56; stroke, 5 mm. The absolute rise was 
6 mm. 

Dog 3, blood-pressure, 110 mm.; pulse, 156; respi- 
ration, 48; stroke, 9 mm. The absolute rise was 
24 mm. 

At 12. 48, dog I, blood-pressure, 107 mm.; stroke, 10 mm. 

Dog 2, blood-pressure, 46 mm. ; stroke, 6 mm. 

Dog 3, blood-pressure, 108 mm.; stroke, 8 mm. 
At 12. 49, the abdominal viscera were severely manipulated in 

the order one, two, three. 
At 12. 50, dog I, blood-pressure, 72 mm., showing an absolute 

loss of 25 mm. 



I40 ON THE BLOOD-PRESSURE IN SURGERY. 

Dog 2, blood-pressure, 24 mm., showing an absolute 
loss of 12 mm. 

Dog 3, blood-pressure, 88 mm., showing an absolute 
loss of 20 mm. ; dog 2 showed a marked tendency 
towards respiratory failure. 
^ At 12.57, the J'lii^d paws of each animal were burned, with the 

results as follows : 

Dog I, blood-pressure, 86 mm.; stroke, 8 mm. 
Dog 2, no effect produced. 
Dog 3, blood-pressure, 94 mm. 
At 12.59, dog 2 died. 

At 1. 22, dog I, blood-pressure, 95 mm.; pulse, 50; respira- 
tion, 60; stroke, 8 mm. 

Dog 3, blood-pressure, 93 mm.; pulse, 46; respi- 
ration, 45; stroke, 10 mm. 
At 1. 3 1. 30, dog I, blood-pressure, 82 mm.; pulse, 74; respi- 
ration, 72; stroke, 8 mm. 

Dog 3, blood-pressure, 73 mm.; pulse, 50; respi- 
ration, 48; stroke, 9 mm. 

At 1.32, dog I, V20 grain of strychnin was injected. Convul- 
sions followed. 

At 1. 38, the intestines were again manipulated. 
Dog I, blood-pressure, 105 mm. 
Dog 3, blood-pressure, 90 mm. 

At 1.59, dog I, blood-pressure, 70 mm. 

Dog 3, blood-pressure, 50 mm. The bandages were 
removed. Blood-pressure, 38 mm. 

At 2.00, dog I, the blood-pressure remained constant. 

Dog 3, the hind paw was burned. Blood-pressure, 
45 mm. ; respiration, slow and spasmodic. 

At 2.03.30, dog I, the sciatic nerve was stimulated. Blood- 
pressure rose to 80 mm. ; both the respiration and 
pulse were quickened. 

At 2.07.30, dog I, blood-pressure, 68 mm.; stroke, 7 mm. 

At 2.08.30, dog I, the intestines were manipulated. Blood- 
pressure, 52 mm. 

At 2.09, dog 3 died. 



ON THE BLOOD-PRESSURE IN SURGERY. 141 

At 2. 10, dog I, the paw was burned, blood-pressure, 53 mm. 

At 2. 1 1, the sciatic was electricahy stimulated. A rise of 7 
mm. in the blood-pressure was recorded. 

At 2. 1 5, manipulation of intestines caused a rise of 3 mm., fol- 
lowed by a fall to the former level. 

At 2.30, blood-pressure, 34 mm. 

At 2.30.30, dog died. 

Experiments 114, 115, 116, 117. 

Whiskey, Digitalis, and Bandaging. 

Dog I , young mongrel ; splendid condition ; weight, 
fourteen kilos. 

Dog 2, mongrel ; fair condition ; weight, twelve 
kilos. 

Dog 3, mongrel; fair condition; weight, ten kilos. 
Dog 4, mongrel ; fair condition ; weight, fifteen 
kilos. 

All reduced to surgical anesthesia; tracheal and ca- 
rotid cannulse were then adjusted. 
At 10.59, preliminary observations: 

Dog I, blood-pressure, 125 mm.; pulse, 168; respi- 
ration, 20. 

Dog 2, blood-pressure, 109 mm.; pulse, 132; respi- 
ration, 18. 

Dog 3, blood-pressure, 109 mm.; pulse, 136; respi- 
ration, 19. 

Dog 4, blood-pressure, 95 mm.; pulse, 128; respi- 
ration, 122. 
At 1 1.30, dog 4 died. 

At 11.38, the intestines, sciatic nerve, and femoral vein of each 

animal were exposed. 
At 1 1.42, dog I, blood-pressure, 99 mm.; pulse, 160; stroke, 

4 mm. 

Dog 2, blood-pressure, 82 mm.; pulse, 168; stroke, 
26 mm. 

Dog 3, blood-pressure, 103 mm.; pulse, 125; stroke, 
14 mm. 



142 ON THE BLOOD-PRESSURE IN SURGERY. 



At 11.45, electrical stimulation of the sciatic nerve of each ani- 
mal was made, resulting as follows : 
Dog I, rise in blood-pressure from 108 mm. to 115 
mm. 

Dog 2, rise in blood-pressure from 84 mm. to 98 mm. 
Dog 3, there was no apparent change in the blood- 
pressure. 

At 12.00, dog I, blood-pressure, 95 mm. 

Dog 2, blood-pressure, 65 mm. 
Dog 3, blood-pressure, 60 mm. 

The sciatic nerve of each animal was electrically stim- 
ulated, after which the following observations were 
made : 

Dog I, blood-pressure, 115 mm. 
Dog 2, blood-pressure, 72 mm. 
Dog 3, blood-pressure, 68 mm. 

At 12.10, dog 2 was bandaged. 

At 12.19, dog I, blood-pressure, 92 mm. 

Dog 2, blood-pressure, 100 mm. 
Dog 3, blood-pressure, 56 mm. 

At 12.19.30, dog I, 15 minims of tincture of digitalis were in- 
jected into the femoral vein. 

Dog 3, V20 grain of strychnin was injected into the 
femoral vein. 

Dog 3, a sustained rise at the time of injection, fol- 
lowed by a fall of the original pressure, occurred. 
Dog I, a gradual and sustained rise of 8 mm. oc- 
curred one minvite after injection. 
At 12.21, dog I, blood-pressure, 95 mm.; pulse, 44; stroke, 
4 mm. 

Dog 2, blood-pressure, 90 mm. ; pulse, 46 ; stroke, 
24 mm. 

Dog 3, blood-pressure, 60 mm. ; pulse, 32 ; stroke, 
12 mm. 

At 12.23, the sciatics were stimulated. 

Dog I, blood-pressure, 95 mm. 
Dog 2, blood-pressure, 98 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 143 

Dog 3, blood-pressure, 57 mm. 
The blood-pressure remained fairly constant. 
At 1. 00, dog I, blood-pressure, 102 mm.; pulse, 168; stroke, 
4 mm. 

Dog 2, blood-pressure, 97 mm.; pulse, 172; stroke, 
22 mm. 

Dog 3, blood-pressure, 92 mm.; pulse, 120; stroke, 
16 mm. 

At 1. 19, dog 3, ^/64 grain of strychnin was injected. This 
caused a rise in the blood-pressure of 6 mm. at the 
time of injection. 

At 1. 19.30, dog I, 7 minims of tincture of digitalis were in- 
jected, causing a rise at time of injection of 10 mm. 

At 1.23, dog I, blood-pressure, 108 mm. 

Dog 2, blood-pressure, 92 mm. 
Dog 3, blood-pressure, 44 mm. 

At 1.25, the sciatic nerves were stimulated. 

At 1. 26, dog I, blood-pressure, no mm.; pulse, 176; stroke, 
4 mm. 

Dog 2, blood-pressure, 90 mm.; pulse, 184; stroke, 
22 mm. 

Dog 3, blood-pressure, 42 mm.; pulse, 144; stroke, 
15 mm. 

At 1.29, dog I, blood-pressure, no mm.; pulse, 184; stroke, 
10 mm. 

Dog 2, blood-pressure, 85 mm.; pulse, 184; stroke, 

21 mm. 

Dog 3, blood-pressure, 45 mm.; pulse, 124; stroke, 

22 mm. 

At 2. 19, dog 3, V3 0 grain of strychnin was injected, causing 
a rise in the blood-pressure at the time of injection 
of 5 mm. 

At 2.20.30, dog I, 45 minims of tincture of digitalis were in- 
jected. No change occurred in the blood-pressure. 
Dog I, blood-pressure, no mm.; pulse, 192. 
Dog 2, blood-pressure, 152 mm. 
Dog 3, blood-pressure, 46 mm.; pulse, 176. 



144 BLOOD-PRESSURE IN SURGERY. 

At 2.28, the sciatic nerve of each animal was stimulated. An 

abrupt rise and fall in the blood-pressure was recorded. 
At 3.22, dog I, blood-pressure, 116 mm.; pulse, 184. 

Dog 2, blood-pressure, 182 mm.; pulse, 160. 

Dog 3, blood-pressure, 40 mm.; pulse, 124. 
At 3.26, dog 3, V64 grain of strychnin was injected. 

Dog I, 7 minims of digitalis were injected. 
At 3.28, dog I, blood-pressure, 122 mm.; pulse, 176. 

Dog 2, blood-pressure, 82 mm.; pulse, 136. 

Dog 3, blood-pressure, 48 mm.; pulse, 120. 

Dog I, in convulsions. 
At 3.32, dog I, blood-pressure, 115 mm. 

Dog 2, blood-pressure, 80 mm. 

Dog 3, blood-pressure, 86 mm. 

The sciatics were stimulated and a rise and fall in 

the blood-pressure occurred. 
At 4. 1 5, dog I, blood-pressure, 105 mm.; pulse, 176. 

Dog 2, blood-pressure, 72 mm.; pulse, 116. 

Dog 3, blood-pressure, 26 mm.; pulse, 128. 
At 4. 16, the sciatics were stimulated. 

Dog I, blood-pressure, 120 mm., falling to 105 mm. 

Dog 2, blood-pressure, 78 mm., falling- to 72 mm. 

Dog 3, no effect. 
At 4.21, clog 3 manifested evidence of respiratory failure. 
At4.27, dog I, blood-pressure, 105 mm. 

Dog 2, blood-pressure, 74 mm. 
At 4.28, dog I, 10 minims of tincture of digitalis were injected. 

Blood-pressure, 114 mm.; pulse, 148. 
At 4.30, dog 3 died of respiratory failure. 

At 4.34, the sciatics were stimulated, causing an abrupt rise and 
fall in the blood-pressure of each animal. 

At 4.52, dog I, blood-pressure, 97 mm. ; pulse, 172. 

Dog 2, blood-pressure, 70 mm. ; pulse, 140. 

At 4.53, the sciatics were stimulated. The usual rise and fall 
followed. 

At 5.23, dog I, blood-pressure, 79 mm.; pulse, 175. 

Dog 2, blood-pressure, 63 mm.; pulse, 176. 



.J 



ON THE BLOOD-PRESSURE IN SURGERY. 

At 5.27, dog I, 10 minims of tincture of digitalis were injected 
The blood-pressure rose 6 mm. and was maintained. 

At 5.28, the sciatics were again stimulated, showing active 
vasomotor functions in each animal. 

At 5.43, dog 2 showed evidence of respiratory failure. 

At 5.45, dog 2 died. 

At 5.47, dog I, the sciatic was stimulated ; the vasomotors were 
active. 

From 5.49 to 6.36, dog i received three injections of tincture 
of digitalis, — 10 minims, 15 minims, and 22 minims. 
Following each injection there was a rise of 8 milli- 
metres. Three stimulations of the sciatics gave re- 
sults similar to the preceding. 

At 5.49, blood-pressure, 78 mm.; pulse, 156. 

At 6.36, blood-pressure, 80 mm.; pulse, 184. 

From 6.44 to 7.10, 22 minims of tincture of digitalis were in- 
jected. A rise of 14 mm. in the blood-pressure oc- 
curred. 

At7. 10, while stimulating the sciatic nerve, the heart suddenly- 
stopped. Blood-pressure, 58 mm. ; respiration con- 
tinued for two minutes. 

At 7. 1 2, the dog died. 

Experiments 118, 119, 120, 121. 

Strychnin, Digitalis, Whiskey. 

Dog I, male mongrel; good condition; weight, seven 
kilos. 

. Dog 2, female mongrel; good condition; weight, 
forty-five kilos. 

Dog 3, male mongrel; good condition; weight, 
forty-five kilos. 

Dog 4, female mongrel ; weight, forty-five kilos. 
At 12.25, ether anesthesia. Tracheal and carotid cannulae were 
adjusted. 

Dog I, blood-pressure, 133 mm.; pulse, 168. 
Dog 2, blood-pressure, 118 mm.; pulse, 156. 
10 



146 ON THE BLOOD-PRESSURE IN SURGERY. 



Dog 3, blood-pressure, 134 mm.; pulse, 172. 

Dog 4, blood-pressure, 135 mm.; pulse, 160. 

The animals were reduced to shock by exposing the 

intestines, the sciatic nerve, and the femoral vein. 

Dog 4 died. 
At 1. 34, dog I, blood-pressure, 112 mm. 

Dog 2, blood-pressure, 85 mm. 

Dog 3, blood-pressure, 85 mm. 
At 1. 36, dog 2, an injection of V64 grain of strychnin was 

given. Convulsions appeared almost immediately. 

A rise of 5 mm., followed by a fall, was noted at 

the time of injection. After the convulsion a rise 

of 40 mm. in the blood-pressure occurred. 
At 1. 48, dog I, blood-pressure, 90 mm. 

Dog 2, blood-pressure, 94 mm. 

Dog 3, blood-pressure, 93 mm. 
At 1. 49, the sciatics were stimulated. 

At 1.49.45, dog I, the blood-pressure rose about 2 mm., falling 

again and remaining at the former level. 

Dog 2, the blood-pressure rose, due to convulsions. 

Dog 3, the blood-pressure rose, and then fell, remain- 
ing at the former level. 

Dog I, blood-pressure, 88 mm.; pulse, 180. 

Dog 2, blood-pressure, 95 mm.; pulse, 160. 

Dog 3, blood-pressure, 83 mm.; pulse, 166. 
At 1.52.30, dog I, an injection of 10 minims of digitalis was 

given. The blood-pressure rose to 96 mm. and was 

maintained; pulse, 184. 
At 2.07, dog I, blood-pressure, 88 mm.; pulse, 186. . 

Dog 2, blood-pressure, 72 mm.; pulse, 164. 

Dog 3, blood-pressure, 78 mm. ; pulse, 112. 
At 2.10, the sciatics were stimulated with the following results : 

Dog I. a rise of 2 mm. occurred, followed by a fall. 

Dog 2, a fall of 5 mm. was noted. 

Dog 3, a rise of 2 mm., followed by a fall of 5 mm. 
At 2.43, dog I, blood-pressure, 58 mm.; pulse, 188. 

Dog 2, blood-pressure, 65 mm.; pulse, 172. 

Dog 3, blood-pressure, 85 mm.; pulse, 112. 



ON THE BLOOD-PRESSURE IN SURGERY. u^y 

At 2.44.30, dog I, an injection of 10 minims of tincture of digi- 
talis was made. There occurred a rise of 4 mm., 
which was maintained ; pulse, 184. 

At 2.45, dog 2, an injection of V12 grain of strychnin was 
given. A fall of 14 mm., followed by a rise to the 
former level, was observed; pulse, 164. 

At 2.48, dog 3, respiratory failure occurred, due to MgSOj 
at the time of removing the clot. 

At 2.50, dog I, blood-pressure, 67 mm. 

Dog 2, blood-pressure, 60 mm. 

At 2.51, the sciatics were stimulated with results as follows: 

Dog I, a rise of i mm. occurred, followed by a fall 
to the former level. 

Dog 2, a rise of i mm. occurred, followed by a fall 

to the former level; pulse, 168. 
At 3.05, dog I died from respiratory and heart failure. 
At 3.08, dog 2, repeated convulsions occurred. 
At 3.27, dog. 2 died. 



Experiments 122, 123, 121, 125. 

Strychnin, Digitalis, Whiskey, and Bandaging. 

Dog I, male; good condition; weight, eleven kilos. 
Dog 2, male mongrel ; poor condition ; weight eight 
kilos. 

Dog 3, female spaniel ; poor condition ; weight, eight 
kilos. 

Dog 4, female spaniel ; poor condition ; weight, eight 
kilos. 

Ether anesthesia ; tracheal and carotid cannulse. 
At 1 1.55, dog I, blood-pressure, 145 mm.; stroke, 8 mm.; 
pulse, 148. 

Dog 2, blood-pressure, 98 mm. ; stroke, 9 mm ; pulse, 
108. 

Dog 3, blood-pressure, 134 mm.; stroke, 8 mm.; 
pulse, 180. 

Dog 4, blood-pressure, 90 mm. ; pulse, 180. 



148 ON THE BLOOD-PRESSURE IN SURGERY. 



At 12.36.30, dog 4, grain of strychnin was injected; res- 
piration was very poor. Convulsions occurred shortly 
after injection. 

At 12.37, dog I was given an injection of 10 minims of tinc- 
ture of digitalis. A gradual rise in the blood-pressure 
from 95 to 118 mm. followed and was maintained. 
The stroke at first increased from 4 to 5 mm., then 
decreased to 4 mm. The pulse increased from 212 
to 220. 

At 12.38, dog 2 was injected with 22 minims of whiskey into 
the femoral veins. A gradual rise in the blood- 
pressure occurred from 104 to 112 mm. The stroke 
increased from 7 to 8 mm., and the pulse decreased 
from 128 to 124. 

At 1 2. 44, dog 3 was bandaged. A rise in the blood-pressure 
from 128 to 133 was recorded; pulse, 180; stroke, 
5 to 14 mm. 
Dog I, pulse, 212. 
Dog 2, pulse, 140. 
Dog 3, pulse, 128. 
Dog 4, pulse, 180. 

At 1. 01, the sciatic nerve was mechanically stimulated. 

Dog I, the blood-pressure rose from 88 to 100 mm. 
Dog 2, the blood-pressure rose from 108 to 112 mm. 
Dog 3, the blood-pressure rose from 125 to 140 mm. 
Dog 4, the blood-pressure rose from 125 to 140 mm. 
Dogs I and 3 responded with an abrupt rise in the 
blood-pressure, followed by a sudden fall. 
Dog I, the fall was slow. 

Dog 3, the blood-pressure returned to its former level. 
Dog 2 responded with a slight rise in the blood- 
pressure, followed by a fall of 5 mm. below the for- 
mer level. 
Dog I, pulse, 188. 
Dog 2, pulse, 148. 
Dog 3, pulse, 180. 



ON THE BLOOD-PRESSURE IN SURGERY. 149 

At 1.35, dog 2, blood-pressure, 113 mm.; stroke, 7 mm. 

Dog 3, blood-pressure, 140 mm.; stroke, 2 mm.; 
long respiratory waves. 

At 1. 36, the sciatic nerves were mechanically stimulated. 

Dog I, blood-pressure, 76 mm. ; stroke, 5 mm. 
Dog 2, blood-pressure, 124 mm.; stroke, 8 mm. 
Dog 3, blood-pressure, 142 mm.; stroke, 2.5 mm. 

At 1.39, dog I was injected with 10 minims of tincture of digi- 
talis into the femoral vein. A fall in the blood- 
pressure from 58 to 56 mm. was recorded. The 
stroke increased from 4 to 6 mm. 
Dog 2 was injected with 22 minims of whiskey into 
the femoral vein. The blood-pressure rose from 60 to 
76 mm., and the stroke increased from 6 to 7.5 mm. 

From 1.47 to 1.48, the sciatic nerve was mechanically stimu- 
lated. In dog I the blood-pressure rose from 60 lo 
72 mm. ; the stroke increased from 4 to 5 mm. 
In dog 2 the blood-pressure rose from 64 to 78 mm. ; 
stroke, 67 mm. 

In dog 3 the blood-pressure rose from 124 to 125 
mm. 

Dog I was injected with 10 minims of tincture of 
digitalis into the femoral vein. The blood-pressure 
increased from 58 to 66 mm. ; stroke, 4 to 5 mm. 
Dog 2 was injected with 50 minims of whiskey into 
the femoral vein ; a rise in the blood-pressure from 
109 to III mm. followed; stroke, 9 mm. 
From 3.21 to 3.22, the sciatic nerves were mechanically stimu- 
lated. 

At 3.22, dog I, the blood-pressure rose from 67 to 80 mm.; 
stroke from 5 to 6 mm. 

Dog 2, the blood-pressure rose from 58 to 67 mm. ; 
the stroke fell from 8 to 7 mm. 
Dog 3, no change occurred in the blood-pressure. 
At 3.38, dog I, blood-pressure, 68 mm.; stroke, 4 mm. 

Dog 2, blood-pressure, 1 1 1 mm. ; stroke, 8 mm. 
Dog 3, blood-pressure, 117 mm.; stroke, 5 mm. 



I^O ON THE BLOOD-PRESSURE IN SURGERY. 

At 3.43, the sciatic nerves were stimulated. 
The following was noted : 

Dog I, the blood-pressure rose from 67 to 78 mm.; 
stroke, 4 to 8 mm. 

Dog 2, the blood-pressure rose from 1 11 to 123 mm. ; 
stroke, 8 mm. 

Dog 3, blood-pressure, 117 mm. 
At 4.03, 10 minims of whiskey were given intravenously. A 
rise in the blood-pressure from 108 to 120 mm. was 
noted. The stroke registered 7 mm., then fell to 
6 mm. 

At 4.41, dog I was given 10 minims of tincture of digitalis 

intravenously. A rise in the blood-pressure from 55 

to 67 mm. followed ; stroke, 7 mm. 

Dog 2 was given 22 minims of whiskey intravenously. 

A rise in the blood-pressure of 2 mm. followed; 

stroke, 7 mm. 
At 4.48, the animals were killed by MgS04 solution. 

Experiment 126. 
Is the Cardio-inhibitory Centre exhausted in Shock? 

Dog; male; good condition; weight, nine kilos. 

At 9.48, blood-pressure, 130 mm.; stroke, 8 mm.; pulse, 180. 
The animal was reduced to shock. 

At 10.34, blood-pressure, 30 mm. ; stroke, 10 mm. ; pulse, 120. 

Electrical stimulation of the sciatic nerve produced 
a slight rise in the blood-pressure. 

At 10.36.30, an infusion of adrenalin, i to 200,000, was begun, 
the rate of flow being Yz ounce per minute. A slight 
rise in the blood-pressure followed. The blood- 
pressure rose to no mm.; mechanical stimulation 
of the laryngeal mucosa produced a reflex inhibition 
of the heart. The blood-pressure dropped to 40 mm., 
after which the heart beat slowly and the blood- 
pressure gradually rose to 90 mm. ; later the blood- 
pressure fell. The animal was then killed. 



ON THE BLOOD-PRESSURE IN SURGERY. 151 



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1^2 ON THE BLOOD-PRESSURE IN SURGERY. 

Experiment 127. 
Digitalis, Atropin. 

Dog; male; weight, twenty-six kilos. 

At ii.24<tliere was injected ^/lo^, grain of atropin into the 
jugxilar vein; pulse, 132; respiration, 64. 

At 12.03, both accelerantes were severed. 

At 12.04, blood-pressure, 124 mm.; pulse, 172. 

At 12.05, both vagi were severed; blood-pressure, 120 mm.; 

pulse, 148. On burning the hind foot the blood- 
pressure rose 6 mm. Repetition of the burning, ex- 
posure, and manipulation of the intestines were fol- 
lowed by a progressive fall in the blood-pressure, the 
dog passing into deep shock. After the blood-press- 
ure had fallen to 30 mm. electrical stimulation of the 
sciatic nerve produced no rise in the blood-pressure. 
The animal was then killed. 

Experiment 128. 

Does an Increase in the Heart-Beat cause a Rise in the Blood- 
Pressure? Shock induced in an Animal in which the Nerve 
Connection of the Heart is severed. 

Dog; male; weight, fifteen kilos. Morphin and 
ether anesthesia. 

Preliminary blood-pressure, 150 mm.; pulse, 140. 
On severing the right vagus the blood-pressure rose 
20 mm., followed by a compensatory fall. On sever- 
ing the opposite vagus another rise occurred. On 
severing both accelerantes the blood-pressure fell. • 
After both vagi and accelerantes had been severed, 
burning the feet and electrical stimulation of the sci- 
atic nerve caused a rise in the blood-pressure. Ex- 
posing and manipulating the intestines, skinning the 
dog, etc., caused a decline in the blood-pressure, the 
animal passing into deep shock. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 129. 

Shock produced in an Animal whose Nerve-Supply has been 
cut off. On the Effect of Severing the Vagi and Accele- 
rantes. 

Dog, male ; weight, fifteen kilos. Alorphin and ether 
anesthesia. 

Preliminary blood-pressure, 144 mm.; pulse, 152. 
On burning the hind foot the blood-pressure rose 
to 200 mm. ; pulse, 206 mm. 

On severing both vagi simultaneously the blood- 
pressure rose 5 mm. ; the pulse increased 14. 
On severing both accelerantes the blood-pressure fell 
30 mm. ; the pulse, 6 mm. 

The animal was reduced to surgical shock by burn- 
ing, skinning, and crushing. The animal was then 
killed. 

Experiment 130. 
Repetition of Experiment 129. 

Dog; young female mongrel; weight, eleven kilos. 
Morphin and ether anesthesia. 
Preliminary blood-pressure, 115 mm.; pulse, 168. 
On severing the vagi the blood-pressure rose to 120 
mm. ; pulse, 136. 

After severing both accelerantes the blood-pressure 
registered 140 mm.; then fell to 115 mm.; pulse, 
116. 

On burning the paw and stimulating the sciatic ner\'e, 
the blood-pressure rose. Mechanical stimulation of 
the sciatic nerve was followed by a rise in the blood- 
pressure, but no change in the pulse. The animal 
was reduced to shock and then killed. 



154 ON THE BLOOD-PRESSURE IN SURGERY. 

Experiment 131. 
Repetition of the Preceding. 

Dog; male; weight, sixteen kilos. Morphin and 
ether anesthesia. 

Blood-pressure, io6 mm.; pulse, 140. On severing 
the right vagus the blood-pressure rose to 130 mm.; 
pulse to 140 mm. 

On severing the right accelerantes the blood-pressure 
recorded 80 mm.; pulse, 128. 

On severing the left accelerantes the blood-pressure 
recorded 80 mm.; pulse, no. 

Burning the hind foot was followed by a rise in the 
blood-pressure. 

Skinning the abdomen was followed by a fall to 45 
mm. in the blood-pressure. Exposing and manipula- 
ting the intestines and crushing the feet produced a 
fall in the blood-pressure which continued until the 
animal died of shock. 

Experiment 132. 

Shock, Curare, Vagi severed. 

Mongrel dog ; fair condition ; weight, eleven kilos. 
Ether anesthesia. 

At 9.05, initial blood-pressure, 135 mm.; pulse, 180. The ani- 
mal was reduced to shock by skinning and sponging 
the denuded surface. 

At 9.50, blood-pressure, 80 mm. ; pulse, 164. 

At 10.06, 50 minims of a .5 per cent, solution of curare were 
injected into the femoral vein. This produced a fall 
in the blood-pressure, followed by a rise to the for- 
mer level. Artificial respiration was now supplied. 

At 10.09, blood-pressure, 100 mm. ; pulse, 142. 

Atio. 10, both vagi were severed; a momentary inhibition of 
the heart was noted, followed by a gradual rise in 
the blood-pressure. 



ON THE BLOOD-PRESSURE IN SURGERY. 1^5 

At 10. 13, blood-pressure, 150 mm.; pulse, 160. 
At 10.50, neither the blood-pressure nor the pulse showed vari- 
ations. 

At 1 1. 00, the animal was killed. 

Experiment 133. 
Vagi severed. 

Male mongrel ; fair condition ; weight, thirteen kilos. 
Ether anesthesia. 

Initial blood-pressure, 140 mm.; pulse, 150. 
An injection of i dram of a .5 per cent, solution 
of curare was given intravenously, artificial respira- 
tion being supplied. 

Blood-pressure, 140 mm. ; pulse, 150; both vagi were 
severed. 

Blood-pressure, 1 50 mm. ; pulse, 1 60. 

The blood-pressure and pulse remained constant. 

For a short time there was a gradual rise to 155 mm., 

then a fall to 150 mm., at which height it remained 

for thirty minutes. The animal was then killed with 

MgS04. 

Experiment 134. 

Vagi severed, Curare, Adrenalin. 

Mongrel male ; good condition ; weight, eleven kilos. 
Ether anesthesia. 

Two drams of a .5 per cent, solution of curare were 

injected into the femoral vein. 

Blood-pressure, 125 mm.; pulse, 135. 

Artificial respiration was supplied. 

Both vagi were then severed. 

Blood-pressure, 134 mm.; pulse, 147. 

The rise in the blood-pressure was not sustained, and 

fell to 125 mm. 

An injection of adrenalin, i to 1000, was followed 
by a rise in the blood-pressure to 210 mm.; pulse, 
very rapid. 



•I 



ON THE BLOOD-PRESSURE IN SURGERY. 



This blood-pressure was maintained for one minute, 
after which it fell to 120 mm.; pulse, 160. 
The animal was then killed by MgS04. 

Experiment 135. 

Vagi severed, Curare, Adrenalin. 

Male mongrel ; good condition ; weight, nine kilos. 
Ether anesthesia. 

An injection of i dram of a .5 per cent, solution 
of curare was given into the femoral vein. Artificial 
respiration was supplied. 

Blood-pressure, 125 mm.; pulse, 150. The animal 
was skinned and the denuded surface sponged. 
Blood-pressure, 30 mm. ; pulse, 112. Both vagi were 
severed. 

Blood-pressure, 28 mm.; pulse, 125. The character 
of the stroke prior to severing the vagi was respira- 
tory. After severing the vagi, the stroke was slightly 
modified by respiration. 

Blood-pressure, 28 mm. ; pulse, 125 to 130, which 
was maintained for twenty minutes. 
An injection of 7.5 minims of i to 1000 adrenalin was 
given intravenously. This was followed by a sharp 
rise in the blood-pressure to 225 mm. This height 
was maintained for two minutes. The pulse became 
slow and the stroke was greatly increased in length. 
Atropin in ^/i2o g^3.m doses decreased the length 
of the stroke to 12 mm. The blood-pressure rapidly 
fell to 25 mm. ; pulse, 120. Repeating the above in- 
jection of adrenalin, a similar result was observed, 
the length of the strokes being controlled by atropin. 
The blood-pressure gradually fell to 25 mm. ; pulse, 
196. The animal was killed. Duration of experi- 
ment, three hours and forty minutes. 



ON THE BLOOD-PRESSURE IN SURGERY. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 136. 

Cord and Vagi severed. 

Mongrel female ; good condition ; weight, seventeen 
kilos. Ether anesthesia. 

Blood-pressure, 120 mm.; stroke, to mm.; pulse, 
136. The cord was severed on a level with the 
second cervical vertebra. Artificial respiration was 
supplied. 

Blood-pressure, 70 mm. ; stroke, 18 mm.; pulse, 134. 

Both vagi were severed. 

Blood-pressure fell to 60 mm.; pulse, 106. 

Thirty minims of tincture of digitalis were injected 

into the jugular vein. 

A rise in the blood-pressure to no mm. occurred; 
pulse, 96. A gradual fall soon followed ; pulse, 88 ; 
no change in the length of strokes. 
The injection was repeated. The blood-pressure rose 
to 75 mm., but was not sustained. The pulse varied 
from 82 to 86. The strokes increased in length to 
20 mm. 

The injection of 15 minims of adrenalin into the fem- 
oral vein was followed by a sharp rise in the blood- 
pressure to 150 mm.; stroke, 8 mm.; pulse, 130. 
A repetition of the injection of adrenalin produced a 
similar result. 

The animal was killed. Duration of experiment, one 
hour and twenty minutes. 

Experiment 137. 
Decapitation. 

Female mongrel ; fine condition ; weight, seventeen 
kilos. Ether anesthesia. 
Normal blood-pressure, 132 mm. 
The animal was decapitated, the blood-pressure fall- 
ing to 40 mm. Artificial respiration was maintained, 



ON THE BLOOD-PRESSURE IN SURGERY. j^g 

and a continuous infusion from i to 500,000 adre- 
nalin in normal saline solution was made into the 
femoral vein. A considerable amount of blood was 
lost during the dissection. 

The blood-pressure remained at 60 mm., but re- 
sponded in proportion to the rate of flow. Prior to 
adjusting the rate of flow the blood-pressure rose 
to 200 mm. This was one hour and thirty minutes 
after the animal was decapitated. Intravenous in- 
jections of strychnin and digitalis produced no result. 
The animal was killed, the blood-pressure recording 
45 mm. 

Duration of experiment, two hours and thirty min- 
utes. 

Experiment 138. 
Decapitation. 

Mongrel male ; weight, nine kilos. Ether anesthesia. 
Initial blood-pressure, 125 mm. 
At 10.02, the animal was decapitated by a bloodless dissection. 

Blood-pressure, 35 mm. Artificial respiration sup- 
plied. 

At 10.22, a continuous injection of i to 1000 adrenalin in noi*- 
mal saline solution was begun. The blood-pressure 
varied from 40 to 200 mm., which was proportionate 
to the rate of flow of the solution. Hot-water bottles 
were placed about the animal. There were occasional 
twitchings of the forelegs and three apparently nor- 
mal defecations. 

At 7.30, the heart began to show a slight degree of arrhythmia. 

At 7.45, the blood-pressure reacted sluggishly to the solution. 

Symptoms were progressive. The heart was very 
arrhythmic, and the blood-pressure did not respond to 
adrenalin. 

At 8.30, the animal died. 

Autopsy. — The tissues were anemic. Free fluid, of a fecal 
odor, was in the abdominal cavity. The intestines 



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ON THE BLOOD-PRESSURE IN SURGERY. 



were moderately distended with fluid and were veiy 
pale. The mesenteric vessels were filled with air 
emboli. The stomach contained a small amount of 
fluid. The liver was pale and the vessels contained 
air emboli. The kidneys were anemic and the cap- 
sule was elevated b}' fluid. The spleen was pale, and 
the vessels were filled with air emboli. The lungs 
were also pale and edematous. The heart was pale 
and there was free fluid in the pericardium. The 
cardiac vessels were filled with emboli. The spinal 
chord was edematous, and its vessels contained em- 
boli. The total amount of normal saline solution in- 
jected was 1 125 c.c. 

Experiment 139. 

Decapitation. 

Mongrel male ; good condition ; weight, nine kilos. 
Ether anesthesia. 

Initial blood-pressure recorded 125 mm. 

The animal was decapitated by bloodless dissection. 

Artificial respiration was supplied. 

The blood-pressure fell to 30 mm. 

A continuous injection of a i to 500,000 infusion of 

adrenalin into the femoral veins was begun. 

The blood-pressure reacted in proportion to the rate 

of flow of the solution. 

The animal died, and at autopsy the vessels were 
found to contain air emboli. 

Duration of experiment, three hours and forty min- 
utes. 

Experiment 140. 

Decapitation. 

Mongrel male; good condition; weight, eight kilos. 

Deep anesthesia. 

Initial blood-pressure, 130 mm. 

The animal was decapitated by bloodless dissection. 



ON THE BLOOD-PRESSURE IN SURGERY. 




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Artificial respiration was supplied. 
A continuous injection of a solution of adrenalin 
into the femoral veins was begun. The blood-press- 
ure was proportionate to the rate of flow, which was 
such that the blood-pressure was maintained at 60 
mm. 

After four hours and ten minutes the dog died. 

Experiment 141. 
Decapitation. 

Mongrel male; good condition; weight, nine kilos. 

Ether anesthesia. 

Initial blood-pressure, 125 mm. 

The animal was decapitated by bloodless dissection, 
artificial respiration being supplied. 
The blood-pressure fell to 40 mm. 
A continuous injection of i to 100,000 infusion of 
adrenalin in the femoral vein was begun. The blood- 
pressure was maintained at 70 mm. During the time 
prior to accurate adjustment of the rate of flow the 
blood-pressure alternately rose and fell, having a 
maximum height of 200 mm. and a minimum fall to 
40 mm. 

The animal died. 
Autopsy. — The vessels were found to contain air emboli. 

Duration of experiment, two hours and twenty min- 
utes. 

Experiment 142. 
Decapitation. 

Mongrel female; good condition; weight, fifteen 
kilos. 

Initial blood-pressure, 135 mm. 

The technique employed in this experiment was the 
same as that in the previous experiment. 
The results obtained agree in every particular with 
the previous decapitation experiment. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Death was due to air emboli. 

Duration of experiment, six hours and fifteen min- 
utes. 

Experiment 143. 

Cocainizing the Medulla. 

Mongrel dog; weight, eleven kilos. Ether anes- 
thesia. 

Initial blood-pressure recorded 115 mm. 
The triangular space at the base of the skull was ex- 
posed at the membrane punctured with a hypodermic 
needle. 

An injection of 22 minims of a two per cent, solution 
of cocain was made. Withdrawing the needle caused 
some cerebrospinal fluid to escape. Immediately 
following the injection the blood-pressure fell to 50 
mm. and respiration ceased. Artificial respiration 
was supplied. 

Burning the paw and electrically stimulating the sci- 
atic nerve produced no effect upon the blood-pressure. 
No change occurred when the finger was introduced 
into the larynx or when the box of the larynx was 
crushed. 

The blood-pressure soon rose to 65 mm. When -^/jq 
grain of strychnin was injected into the femoral vein, 
stiffening of the muscles ensued and a slight con- 
vulsion, two minutes' duration, occurred. There was 
no change in the blood-pressure. Following the in- 
jection of 22 minims of adrenalin the blood-pressure 
rose to 250 mm. and was sustained nearly two min- 
utes; subsequent injections produced similar changes. 
The animal was killed by asphyxia. 



l68 ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 144. 

Cocainizing the Medulla. 

Male hound; good condition; weight, fifteen kilos. 
Ether anesthesia. 
At 9.30, initial blood-pressure, 130 mm. 

At 10.00, the medulla was exposed. No change occurred in 
the blood-pressure. A considerable amount of cere- 
brospinal fluid escaped. 

At 10.02, 22 minims of a two per cent, solution of cocain were 
dropped upon the exposed medulla. The blood-press- 
ure immediately fell to 70 mm. 

Another application of 22 minims of a two per cent, 
solution of cocain was made. Complete paralysis 
followed. Artificial respiration was supplied. The 
blood-pressure momentarily rose, then fell to the for- 
mer level. 

At 10.04, tlie right paw was burned. No change occurred in 

the blood-pressure. 
At 10.06, the left sciatic was electrically stimulated. No change 

was noted. 

Blood-pressure, 55 mm. The integument was re- 
moved. The blood-pressure fell slightly. 
The intestines were exposed and manipulated, after 
which there occurred a gradual fall in the blood- 
pressure. 
At 10. 17, blood-pressure, 35 mm. 

At 10.45, blood-pressure, 3^ Burning the paw produced 

no change. 
At 1 1. 10, blood-pressure, 30 mm. 

At 1 1.32, blood-pressure, 30 mm. The sciatic nerve was stimu- 
lated, causing no alteration in the blood-pressure. 

At 11.50, Vao grain of strychnin was injected. 

At 1 1. 5 1, tetanic contractions occurred; the blood-pressure 
rapidly fell to 30 mm. where it continued unchanged. 
During this later period there were many convulsions, 



ON THE BLOOD-PRESSURE IN SURGERY. 



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170 ON THE BLOOD-PRESSURE IN SURGERY. 



but the blood-pressure remained unchanged. The 
animal was killed. The blood-pressure recorded 30 
mm. 

Experiment 145. 

Cord and Medulla cocainized. 

Male dog; good condition; weight, eleven kilos. 
Ether anesthesia. 

The medulla was bloodlessly exposed as in the pre- 
vious experiment. The cord was bloodlessly exposed 
on a level with the fourth lumbar vertebra. The 
carotid cannula was adjusted. 

At 11.52, blood-pressure, 105 mm. The animal was elevated, 
allowing the cerebrospinal fluid to escape from the 
wound, thus facilitating cocainization of the cord. 

At 11.55, 22 minims of a two per cent, solution of cocain were 
injected into the subarachnoid space, the animal being 
inclined feet downward. The injection was repeated, 
the animal being placed on the right side. 
Fifteen minims were dropped upon the medulla. The 
application of cocain was followed by a sharp fall in 
the blood-pressure, to 45 mm. 

At 11.58, a gradual rise in the blood-pressure began. 

At 11.59.30, burning the paw produced no change. 

At 12.00, electrical stimulation of the sciatic nerve catised no 
change. 

At 12.01, ^/i2 grain of strychnin was injected into the femoral 
vein. The blood-pressure was unchanged. 

At 12.04, burning the paw caused no change. Blood-pressure, 
70 mm. This rise, which was inaugurated at 11.58, 
attained its maximum. 

At 12.05, slight twitchings were observed in the left hind foot 
when lightly tapped. There was no response in other 
parts of the body following stimulation, the paralysis 
being complete with the exception of the leg. The 
blood-pressure began a gradual decline. 

At 12.06, blood-pressure, 50 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



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172 ox THE BLOOD-PRESSURE IX SURGERY. 

At 12.07. blood-pressure. 40 mm.; slight reflexes were noted. 
At 12.10, blood-pressure. 30 mm. Slight typical convulsions 
occurred. 

At 12.15, blood-pressure. 22 mm. Burning the paw produced 
no change. The cord was again cocainized without 
change of the conditions. Slight convulsions occa- 
sionally occurred. 

At 12.29, blood-pressure. 3^ mm. Burning produced no 
change in the blood-pressure and the muscular twitch- 
ing had discontinued. 

At 12.29.30,^/12 grain of adrenalin was injected into the fem- 
oral vein. The blood-pressure rose abruptly to 185 
mm. The heart executed a regular action. 

At 12.30, blood-pressure, 210 mm. 

At 12.31, blood-pressure, 185 mm. 

At 12.34, blood-pressure, 185 mm. A steady decline in blood- 
pressure began. 

At 12.41, blood-pressure. 70 mm. Continuous twitchings of 

the muscle were present. 
At 12.42, burning of the paw caused slight momentary rise in 

the blood-pressure. 
At 12.44, blood-pressure, 60 mm. Burning the paw caused a 

slight rise in the blood-pressure, followed by an equal 

fall. 

At 12.46. blood-pressure, 50 mm. : the stroke suddenly became 
ver\- short. Xo further tracings of the heart beats 
were obtainable. The blood-pressure remained at 50 
mm. 

There were no clots. The pulse was rapid. The ani- 
mal remained in this condition for thirty minutes and 
was then killed. 

Cocainization of the Stellate Ganglia. 

The object of this series of experiments was to de- 
termine whether or not the suspension of the function 
of the stellate ganglia prevented shock. At first the 
ganglia were exposed and cocain applied directly. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Later, by means of a long needle, cocainization was 
attempted by penetrating the first intercostal space 
and injecting the cocain into the ganglia. In order 
to determine at autopsy the success in properly 
placing the injection, the cocain solution was colored 
with methylene blue. 

Experiment 146. 

Mongrel dog ; fair condition ; weight, seventeen 
kilos. Morphin and ether anesthesia. 
Preliminary blood-pressure, 165 mm.; pulse, 170. 
A two per cent, solution of cocain stained with methy- 
lene-blue was injected into the stellate ganglia. 
During the injection of 22 minims of a two per cent, 
solution of cocain the blood-pressure fell to 80 mm. 
and the pulse to 1 56. 

Both vagi were then cocainized. The blood-pressure 
in the mean time had risen to 120 mm. 
To test whether or not the afferent impulses were 
interrupted, the hind paw was burned. A temporary 
rise in the blood-pressure followed, after which it fell 
to a point lower than it was before the burning. The 
abdomen was then extensively incised. No change 
in the blood-pressure followed. 

On skinning the abdomen and flanks the blood-press- 
ure fell to 55 mm.; pulse, 114. Further bloodless 
dissection was followed by an increased fall in the 
blood-pressure and the pulse-rate. Shock developed 
approximately with the same facility as with the con- 
trol animals. 

Autopsy. — The stellate ganglia were carefully exposed, and 
found to have been stained blue, showing a successful 
application of the cocain upon them. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 147. 

Cocainization of the Stellate Ganglia. 

Small dog ; fair condition ; weight, nine tcilos. Mor- 
phin and ether anesthesia. 

Preliminary blood-pressure recorded 135 mm.; pulse, 
188. 

During the injection of 22 minims of a two per cent, 
solution of cocain into the right stellate ganglion the 
blood-pressure rose to 140 mm., the pulse falling to 
162. 

During the injection of the left stellate ganglion the 
blood-pressure rose to 145 mm., the pulse falling to 
152- 

Both vagi were severed. 

Blood-pressure, 170 mm.; pulse, 172. 

The integument of the abdomen was then removed. 

Blood-pressure, 155 mm.; pulse, 174. 

The animal was fvirther skinned and the raw surface 

irritated. 

Blood-pressure, 125 mm.; pulse, 154. 
The fore-foot was burned. 
Blood-pressure, 150; pulse, 180. 
The opposite hind foot was burned. 
Blood-pressure, 160 mm.; pulse, 168. 
On account of the change in the pulse-rate upon ap- 
plication of the flame, it was apparent that there was 
a defect in the cocanization. 
The animal was killed. 
Autopsy. — Staining of the tissues around the ganglia was 
observed. Previous to the two experiments here 
recorded a number of dissections were made for 
the purpose of more accurately fixing the location 
and the landmarks of the ganglia. In several experi- 
ments the ganglia were exposed by deep dissection of 
the neck, and cocain was directly applied. This ne- 
cessitated such extensive bilateral dissection that the 



ON THE BLOOD-PRESSURE IN SURGERY. 



animals were reduced to such a degree of shock be- 
fore the means of prevention could be applied, that 
even if the experiments, from this point of view, had 
been successful, these still would have been inconclu- 
sive. Through respiratory failure and the rapid 
development of shock, which was not modified by 
injection of cocain into the stellates, the animals were 
lost. 

On the Effect upon the Circulation of Various Forms of 

Pressure. 

Description of Special Apparatus. — In the preliminary experi- 
ments of water-pressure a water-tight box was 
arranged, with openings through which the tubes 
passed recording the blood-pressure and the respira- 
tion, and affording means of respiration to the animal. 
This was immediately found to be impractical. Rub- 
ber bags were then experimented upon in an attempt 
to give mechanical assistance to the general circula- 
tion. This likewise proved impractical. A cast-iron 
cylinder five feet in length and two feet in diameter 
was then used. The ends were closed with large 
metal caps, resting against gaskings, and fastened by 
twelve heavy bolts. Holes were drilled through the 
metal cylinder, through which tubes might be passed. 
At first the pressure gauge communicated with the in- 
terior of the cylinder, indicating, but not recording, 
the pressure. Later on, a mercurial manometer was 
attached, recording the pressure on a drum. In 
these experiments a respiratory apparatus could not 
be successfully employed. The difficulty was finally 
overcome by placing a small rubber bag upon the 
thorax of the animal, over which an encircling band 
was snugly pinned. The tubing was connected with 
a mercurial manometer which recorded the respira- 
tion. The pressure was increased by using a hand 
air-pump, and lowered by means of an escape cock. 
Fresh air was introduced at frequent intervals. 



176 ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 14>8. 

Mongrel dog; good condition; weight, 5.73 kilos. 
Morphin and ether' anesthesia. The carotid cannula 
was connected with the manometer. 
At 10.40, pulse, 172; respiration, 48. 

At 10.54, tube-jDressure, o mm; blood-pressure, no mm.; 
pulse, 168; respiration, 52. 



A 



B 



c 




Fig. 29. — Exp. 14S. — A, ^utnial piv^-siiru ; />, intiatlioiacic pressure; C, pressure in the tube. 
Note the correspondence among the pressures. 

At 10.57, tube-pressure, 44 nim. ; blood-pressure, i6o mm.; 

pulse, 164; respiration, 40. 
At I i.oo, tu1)e-pressure, 20 mm.; blood-pressure, 135 mm.; 

pulse, 132; respiration, 48. 
At 1 1. 01, tube-pressure, o mm.; blood-pressure, 115 mm.; 

pulse, 144; respiration, 56. 
At 1 1.02, tube-pressure, 40 mm.; blood-pressure, 160 mm.; 

pulse, 166; respiration, 144. 



ON THE BLOOD-PRESSURE IN SURGERY. 177 

At 1 1.05, tube-pressure, 60 mm.; blood-pressure, 180 mm.; 

pulse, 132; respiration, 48. 
At 1 1.06, tube-pressure, 20 mm.; blood-pressure, 130 mm.; 

pulse, 144; respiration, 48. 
At 1 1.07, tube-pressure, o mm.; blood-pressure, no mm.; 

pulse, 120; respiration, 56. 
At 1 1.20, the spinal cord was severed in the upper dorsal region. 
At 1 1.25, tube-pressure, o mm.; blood-pressure, 80 mm.; 

pulse, 150; respiration, 42. 
At 1 1.26, tube-pressure, 40 mm.; blood-pressure, 130 mm.; 

pulse, 138; respiration, 40. 
At 1 1.30, tube-pressure, 20 mm.; blood-pressure, no mm.; 

pulse, 156; respiration, 136. 

Severe shock follov^ed the severing of the cord, the 

blood-pressure falling rapidly to 40 mm. Pressure in 

the tube improved with the force of the heart and the 

depth of the respiration. 
At 1 1.43, tube-pressure, 10 mm.; blood-pressure, 100 mm.; 

pulse, 136; respiration, 36. 
At 1 1.45, tube-pressure, o mm.; blood-pressure, 85 mm.; 

pulse, 160; respiration, 20. 
At 1 1.47, the injection of 40 ounces of normal saline into the 

abdominal cavity was followed by trembling in the 

forelegs and neck. 
At 1 1.48, the injection was discontinued and the animal was re- 
placed in the tube; pulse, 136; respiration, 36. 
At 1 1.50, tube-pressure, o mm.; blood-pressure, 95 mm.; 

pulse, 168; respiration, 42. 
At 1 1.5 1, tube-pressure, 30 mm.; blood-pressure, no mm.; 

pulse, 156; respiration, 24. 
At 1 1.54, tube-pressure, 25 mm.; blood-pressure, 100 mm.; 

pulse, 168; respiration, 32. 
At 1 1.57, tube-pressure, 30 mm.; blood-pressure, no mm.; 

pulse, 156; respiration, 28. 
At 11.59, tube-pressure, ^ mm.; blood-pressure, 53 mm.; 

pulse, 152; respiration, 28. 

12 



178 ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.01, tube-pressure, 35 mm.; blood-pressure, no mm.; 

pulse, 160; respiration, 28. 
At 12.04, tube-pressure, 30 mm.; blood-pressure, 105 mm.; 

jDulse, 160; respiration, 32. 
At 12.05, tube-pressure, o mm.; blood-pressure, 75 mm.; 

pulse, 156; respiration, 32. 
At 12.07, tube-pressure, 40 mm.; blood-pressure, 115 mm.; 

pulse, 144; respiration, 26. 
At 12. 1 1, tube-pressure, o mm.; blood-pressure, 75 mm.; 

pulse, 144; respiration, 20. 
At 12.13, tube-pressure, 4° mm.; blood-pressure, 120 mm.; 

pulse, 144; respiration, 24. 
At 12.14, tube-pressure, o mm.; blood-pressure, 75 mm.; 

pulse, 134; respiration, 24. 
At 12.15, tube-pressure, 4° mm.; blood-pressure, 120 mm.; 

pulse, 140; respiration, 24. 
At 12.17, tube-pressure, 32 mm.; blood-pressure, no mm.; 

pulse, 136; respiration, 24. 
At 12.19, tube-pressure, o mm.; blood-pressure, 70 mm.; 

pulse, 140; respiration, 28. 
At 12.23, tube-pressvtre, o mm.; blood-pressure, 70 mm.; 

pulse, 144; respiration, 24. 
At 12.24, tube-pressure, 4° mm.; blood-pressure, 115 mm.; 

pulse, 148; pulse, 24. 
At 12.25, tube-pressure, o mm.; blood-pressure, 75 mm.; 

pulse, 144; respiration, 24. 
At 12.27, tube-pressure, ^ mm.; blood-pressure, no mm.; 

pulse, 136; respiration, 24. 
At 12.30, tube-pressure, o mm.; blood-pressure, 72 mm.; 

pulse, 144; respiration, 24. 
At 12.32, tube-pressure, 42 mm.; blood-pressure, 115 mm.; 

pulse, 128; respiration, 28. 
At 12.33, tube-pressure, ^ mm.; blood-pressure, 70 mm.; 

pulse, 140; respiration, 24. 
At 12.40, tube-pressure, o mm.; blood-pressure, 70 mm.; 

pulse, 150; respiration, 36. 
At 12.42, tube-pressure, 40 mm.; blood-pressure, 120 mm.; 

pulse, 144; respiration, 26. 



ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.45, tube-pressure, 35 niin. ; blood-pressure, no mm.; 

pulse, 140; respiration, 26. 
At 12.47, tube-pressure, o mm.; blood-pressure, 70 mm.; 

pulse, 136; respiration, 28. 
At 12.50, tube-pressure, o mm.; blood-pressure, 70 mm.; 

pulse, 144; respiration, 24. 
At 12.54, tube-pressure, o mm.; blood-pressure, 70 mm.; 

pulse, 120; respiration, 20. 
At 12.55, the dog was removed from the tube; the front legs 

were stiff and trembling. 

Blood-pressure, 60 mm.; pulse, 132; respiration, 20. 
At 1. 00, blood-pressure, 60 mm.; pulse, 120; respiration, 22. 

The heart-beats were spasmodic and vagal in char- 
acter; the respirations were spasmodic. The heart 
ceased before the respirations. 

At the moment of death the blood-pressure was o mm. 
Autopsy. — There was general congestion of the splanchnic 
area. No fluid was in the intestines or stomach. The 
bladder and gall-bladder were distended. The spleen 
and pancreas were normal. There was no fluid in 
the thoracic cavity and no congestion of the thorax. 
The vessels of the ribs and the heart were dilated. 
Five hundred c.c. were recovered from the abdominal 
cavity. More than 100 c.c. were absorbed. 

Experiment 149. 
Pneumatic Pressure. 

Mongrel dog; good condition; weight, 7.88 kilos. 
Ether and morphin anesthesia. The carotid was con- 
nected with the blood-pressure manometer and the 
respiratory apparatus attached. 

At 3.55, blood-pressure, 120 mm.; pulse, 180; respiration, 60. 
The dog was placed in the tube. 

At 3.58, tube-pressure, 85 mm.; blood-pressure, 200 mm.; 
pulse, 160; respiration, 52. 

At 4.00, tube-pressure, o mm. ; blood-pressure, 1 10 mm. ; pulse, 
128; respiration, 56. 



l8o ON THE BLOOD-PRESSURE IN SURGERY. 



At 4.08, the dog was removed from the tube. 
At 4.20, the spinal cord was severed in the upper dorsal region. 
The breathing was labored. 

Blood-pressure, 90 mm. ; pulse, 176; respiration, 72. 
At 4.29, tube-pressure, o mm. ; blood-pressure, 100 mm. ; pulse, 

168; respiration, 60. 
At 4.34, tube-pressure, 100 mm.; blood-pressure, 205 mm.; 

pulse, 200; respiration, 48. 
At 4.36, tube-pressure, o mm. ; blood-pressure, 100 mm. ; pulse, 

200; respiration, 60. 
At 4.45,tube-pressure, o mm. ; blood-pressure, 90 mm. ; pulse, 

192; respiration, 40. 

The dog was removed from the tube. 
At 4.50, 600 c.c. of normal saline were injected into the ab- 
dominal cavity. The animal was replaced in the 

tube. 

At 4.52, tube-pressure, o mm.; blood-pressure, 90 mm.; pulse, 
184; respiration, 36. 

At 4.56, tube-pressure, o mm. ; blood-pressure, 90 mm. ; pulse, 
200 ; respiration, 40. 

At 4.58, tube-pressure, o mm.; blood-pressure, 80 mm.; pulse, 
192; respiration, 40. 

At 5.01, tube-pressure, 100 mm.; blood-pressure, 192 mm.; 
pulse, 196; respiration, 32. 

At 5.07, tube-pressure, o mm. ; blood-pressure, 60 mm. 

At 5.23, the dog appeared to be dying; the contractions of the 
heart were increased in force and of the vagal type. 

Autopsy. — The subcutaneous tissues were anemic; the blad- 
der was distended and contained 105 c.c. of fluid. 
The intestines were pale and contracted. The 
stomach contained about 100 c.c. of fluid, and was 
very pale. The spleen was smaller than usual, the 
color normal. The liver was nor-mal, and bled freely 
on cutting. The superior and inferior vena cavi 
were much distended ; the gall-bladder was full ; the 
thoracic vessels and the lungs were congested; the 
heart was distended and stopped in diastole. Five 



ON THE BLOOD-PRESSURE IN SURGERY. jgi 



hundred c.c. of fluid were removed from the peri- 
tonea] cavity. Twenty c.c. were absorbed in thirty- 
three minutes. 

Experiment 150. 
Pneumatic Pressure. 

Mongrel dog; good condition; weight, twenty 

pounds. Morphin and ether anesthesia. 
At 1 1.25, tube-pressure, o mm.; blood-pressure, 150 mm.; 

pulse, 196; respiration, 36. 
At 11.26, tube-pressure, 66 mm.; blood-pressure, 200 mm.; 

pulse, 186; respiration, 36. 
At 11.28, tube-pressure, o mm.; blood-pressure, 150 mm.; 

pulse, 182; resjSiration, 40. 
At 1 1.30, tube-pressure, 60 mm.; blood-pressure, 200 mm.; 

pulse, 168; respiration, 36. 
At 1 1.32, tube-pressure, 30 mm.; blood-pressure, 180 mm.; 

pulse, 168; respiration, 36. 
At 1 1.34, tube-pressure, o mm.; blood-pressure, 150 mm.; 

pulse, 180; respiration, 40. 

Experiment 151. 
Pneumatic Pressure. External Respiration. 

The same dog that was used in the previous experi- 
ment. The tube was arranged for external respira- 
tion. 

At 1 1.50, tube-pressure, o mm.; blood-pressure, 145 mm.; 

pulse, 180; respiration, 36. 
At 12.02, tube-pressure, o mm.; blood-pressure, 140 mm.; 

pulse, 180; respiration, 40. 
At 12.03, tube-pressure, 15° mm.; blood-pressure, 280 mm.; 

pulse, 140 spasmodic. 

The pulse was of the vagal type. 

The blood-pressure ranged from 240 mm. to 300 mm. 
At 12.06, tube-pressure, o mm.; blood-pressure, 100 mm.; 

pulse, 75 ; respiration, irregular. 



ON THE BLOOD-PRESSURE IN SURGERY. 




184 ON THE BLOOD-PRESSURE IN SURGERY. 

At 12.10, tube-pressure, 100 mm.; blood-pressure, 170 mm.; 
pulse, 96; respiration, 16. 

Experiment 152. 
Pneumatic Pressure. Spinal Cord Severed. 

Mongrel dog; weight, twenty-four pounds. Mor- 
phin and ether anesthesia. 

The respiratory and blood-pressure apparatus were 
connected. 

At 3.05, normal tracing : blood-pressure, 140 mm.; pulse, 186; 
respiration, 66. 

At 3.30, the cord was severed in the dorsal region. A momen- 
tary rise, then a fall, in the blood-pressure followed. 

At 3.32, blood-pressure, 85 mm.; pulse, 136; respiration, 78. 

At 3.40, blood-pressure, 55 mm.; pulse, 90; respiration, 48. 

At 3.43, tube-pressure, 105 mm.; blood-pressure, 150 mm.; 
pulse, 100; respiration, 20. 

At 3.47, tube-pressure, o mm. ; blood-pressure, 65 mm. ; pulse, 
112; respiration, 34. 

At 3.52, tube-pressure, 100 mm.; blood-pressure, 150 mm.; 
pulse, 100; respiration, 20. 

At 3.55, tube-pressure, o mm.; blood-pressure, 65 mm.; pulse, 
96; respiration, 20. 

Experiment 153. 

Pneumatic Pressure. 

Mongrel dog ; good condition ; weight, sixteen kilos. 
Morphin and ether anesthesia. 
At 12.12, blood-pressure, 120 mm.; pulse, 148; respiration, 
144. 

At 12.47, tube-pressure, ^^o mm.; blood-pressure, 240 mm.; 

pulse, 132; respiration, 29. 
At 12.51, tube-pressure, 85 mm.; blood-pressure, 200 mm.; 

pulse, 140; respiration, 30. 



ON THE BLOOD-PRESSURE IN SURGERY. 185 

At 12.53, tube-pressure, 50 mm.; blood-pressure, 170 mm.; 

pulse, 140; respiration, 32. 
At 12.54, tube-pressure, o; blood-pressure, 120 mm.; pulse, 

148; respiration, 32. 
At 1. 00, tube-pressure, 120 mm.; blood-pressure, 240 mm.; 

pulse, 136; respiration, 30. 
At 1.07, tube-pressure, 50 mm.; blood-pressure, 170 mm.; 

pulse, 136; respiration, 30. 
At 1. 09, no tube-pressure; blood-pressure, 120 mm.; pulse, 

136; respiration, 32. 

Experiment 154. 
Pneumatic Pressure. 

Bull dog ; good condition ; weight, sixteen kilos. 
Morphin and ether anesthesia. 

A thin rubber bag filled with water was placed in the 
abdomen and connected with a rigid tube, which was 
connected in turn with a mercury manometer. The 
tube was supplied with a small stop-cock. 

At 4.45, tube-pressure, o mm.; abdominal pressure, o mm,; 

blood-pressure, 160 mm. ; pulse, 128; respiration, 16. 

At 4.47, tube-pressure, 47 mm. ; abdominal pressure, 60 mm. ; 

blood-pressure, 280 mm.; pulse, 132; respiration, 24. 

At 4.50, tube-pressure, o mm.; abdominal pressure, o mm.; 

blood-pressure, 160 mm.; pulse, 132; respiration, 
116. 

At 4.52, tube-pressure, 80 mm.; abdominal pressure, 70 mm.; 

blood-pressure, 280 mm. ; pulse, 144; respiration, 20. 
At 4.55, tube-pressure, o mm.; abdominal pressure, normal; 

blood-pressure, 160 mm. ; pulse, 200; respiration, 24. 
At 5.00, tube-pressure, 90 mm. ; abdominal pressure, 90 mm. ; 

blood-pressure. 260 mm. ; pulse, 152; respiration, 20. 
At 5.02, tube-pressure, o mm.; abdominal pressure, normal; 

blood-pressure, 160 mm.; pulse, 162; respiration, 20. 
At 5.04, tube-pressure, 90 mm.; abdominal pressure, 90 mm.; 

blood-pressure, 260 mm. ; pulse, 160; respiration, 18. 



l86 ON THE BLOOD-PRESSURE IN SURGERY. 



At 5.07, tube-pressure, 80 mm.; abdominal pressure, normal; 

blood-pressure, 150 mm.; pulse, 188; respiration, 36, 
of Cheyne-Stokes character. 




Experiment 155. 
Pneumatic Pressure. External Respiration. 

Dog; good condition; weight, sixteen kilos. Mor- 
phin and ether anesthesia. 

Preliminary blood-pressure, 120 mm.; respiration, 
55; pulse, 160. 



l88 ON THE BLOOD-PRESSURE IN SURGERY. 

The blood-pressure was reduced to 95 mm. 
Intracranial pressure, 28 mm.; pulse, 160; respira- 
tion, 28. 

The animal was placed in a pneumatic tube and the 
trachea connected through an opening in the tube 
with the external air. The animal was then subjected 
to a gradually increasing atmospheric pressure. 
When the pressure in the tube had reached 30 mm. 
the blood-pressure was 140 mm. ; the intracranial 
pressure, 36 mm.; pulse, 160; respiration, 36. Res- 
piration, at this point, became so shallow and labored 
that the animal was killed. 

Experiment 156. 

Effect of Pneumatic Pressure upon the Intracranial 
Circulation. 

Dog ; good condition ; weight, fifteen kilos. Mor- 
phin and ether anesthesia. The apparatus was ar- 
ranged as in Experiment 6. 

Preliminary blood-pressure, 134 mm.; pulse, 150; 
respiration, 28. 

The blood-pressure was reduced to 100 mm. The 
cranial bag registered o mm.; pulse, 160; respira- 
tion, 20. 

The animal was placed in the tube and the respira- 
tory cannula was connected with the external atmos- 
phere. The atmospheric pressure within the tube was 
gradually raised to 30 mm. 

Blood-pressure, 140 mm.; pulse, 200; respiration, 
40 ; cranial bag, 50 mm. 

The atmospheric pressure in the tube was reduced to 
10 mm. 

Blood-pressure, 130 mm.; pulse, 190; respiration, 
35 ; cranial bag, 45 mm. 
The pressure in the tube was released. 
Blood-pressure, 118 mm.; cranial bag, 35 mm.; 
pulse, 185; respiration, 32. 



ON THE BLOOD-PRESSURE IN SURGERY. 189 

It was noticed that as the pressure was increased in 
the tube, respiration became more shallow and la- 
bored, with increased rapidity. 



Experiment 157. 
Treatment of Shock by Means of Pneumatic Pressure. 

Dog; good condition; weight fourteen kilos. Mor- 
phin and ether anesthesia. 

General blood-pressure, 130 mm.; intracranial blood- 
pressure, artificially placed, 40 mm.; pulse, 160. 
At 1 1. 00, the animal was reduced to surgical shock by dissection 

and mechanical stimulation. 
At 1 1.55, blood-pressure, 100 mm.; intracranial pressure, arti- 
ficially placed, o mm.; pulse, 165. 

Bandages were applied as in the previous experiment. 
At 12. 10, blood-pressure, 130 mm.; intracranial pressure, 10 

mm. ; pulse, 160. 
At 12.15, blood-pressure, mm.; intracranial pressure, 15 

mm. ; pulse, 180. 
At 12.25, blood-pressure, ^4^ mm.; intracranial pressure, 16 

mm. ; pulse, 186. 
At 12.30, blood-pressure, 140 mm.; intracranial pressure, 16 

mm. ; pulse, 176. 
At 12.35, blood-pressure, 140 mm.; intracranial pressure, 12 

mm. ; pulse, 204 ; respiration, 50. 
At 12.40, blood-pressure, 140 mm.; intracranial pressure, 12 

mm. ; pulse, 208 ; respiration, 26. 
At 12.50, blood-pressure, 148 mm.; intracranial pressure, 115 

mm.; pulse, 216; respiration, 52. 
At 12.55, blood-pressure, 146; intracranial pressure, 15 ram., 

pulse, 214; respiration, 52. 
At 1. 00, blood-pressure, 146 mm.; intracranial pressure, 115 

mm.; pulse, 196. 
At 1.05, blood-pressure, 146 mm.; intracranial pressure, 16 

mm. ; pulse, 172. 
At 1. 10, blood-pressure, 140 mm.; intracranial pressure, 16 

mm. ; pulse, 180. 



igo ON THE BLOOD-PRESSURE IN SURGERY. 

At 1. 1 5, the bandages were removed. Blood-pressure, 100 

mm. ; intracranial pressure, 8 mm. 
At 1.20, blood-pressure, no mm.; intracranial pressure, 6 

mm. ; pulse, 196. 

It was found necessary to reduce the pressure in the 
cranial bag to o after shock had been induced. 

Experiment 158. 
Shock treated by bandaging. 

Mongrel dog; good condition; weight, fifteen kilos. 
Morphin and ether anesthesia. 

Preliminary general blood-pressure, 132 mm.; intra- 
cranial pressure, o mm. 
The animal was reduced to shock. 
Blood-pressure, 104 mm. ; bandages were applied. 
General blood-pressure, 136 mm. ; intracranial press- 
ure, 1 1 mm. 

The respiration was unimpaired. 
Both pressures were maintained during the applica- 
tion of the bandages. The animal was killed, placed 
in the tube, and subjected to varying pressures. The 
variation of the blood-pressure, the intra-abdominal, 
the intracranial, and the intrathoracic were quite the 
same as in the living animal. 

Experiment 159. 
Shock treated by bandaging. 

Mongrel dog; fair condition; weight, eleven kilos. 
Morphin and ether anesthesia. 

Preliminary blood-pressure, 120 mm.; pulse, 132; 
respiration, 54. 

Intracranial pressure, as well as the general blood- 
pressure was taken. The animal was reduced to 
shock, the blood-pressure recording 90 mm. 
Bandages were then applied firmly upon the extremi- 



ON THE BLOOD-PRESSURE IN SURGERY. igi 

ties and head, and lightly upon the abdomen and 
thorax. The blood-pressure promptly rose to 135 
mm., the cranial pressure to 8 mm., and respiration 
became labored and rapid. 
There was no gastric discharge. 

The blood-pressure and intracranial pressure were 
maintained indefinitely. 

Removal of the bandages was followed by a fall in 
the general blood-pressure, as well as the intracranial 
pressure, to their former level. Reapplication of the 
bandages was followed by a rise in the blood- and 
intracranial pressures. 

Experiment 160. 
Shock treated by bandaging. 

Male dog ; fair condition ; weight, nine kilos. Mor- 
phin and ether anesthesia. 

Preliminary blood-pressure, no mm.; pulse, 155; 
respiration, 45. The animal was reduced to surgical 
shock. 

Blood-pressure, 60 mm. ; pvdse, 186; respiration, 52. 
Rubber bandages were then firmly applied over the 
extremities and lightly over the abdomen and thorax. 
Blood-pressure, iiomm. ; pulse, 190; respiration la- 
bored. 

The gastric contents were not discharged. 
The bandages were allowed to remain during the 
period in which compensation usually occurred. The 
blood-pressure in that period remained constant, with 
a tendency towards a slight gradual rise. When the 
bandages were removed the blood-pressure fell to 
the point it was before the application. During 
this time an intracranial pressure was taken and it 
responded precisely to the changes that occurred in 
the general blood-pressure. During the application 
of the bandages it rose, and fell with their removal. 



ON THE BLOOD-PRESSURE IN SURGERY. 



EXPEEIMENT 161. 

Shock treated by Pneumatic Pressure. 

Male mongrel dog; good condition; weight, thirteen 
kilos. Morphin and ether anesthesia. 
Preliminary blood-pressure, 140 mm. (femoral ar- 
tery). 

Cranial pressure was placed at 20 mm. The animal 
was reduced to moderate shock and placed in a tube. 
Tube-pressure, 35 mm.; blood-pressure, 150 mm.; 
cranial pressure, 50 mm. 

Tube-pressure, o mm. ; blood-pressure, 120 mm. ; cra- 
nial pressure, 20 mm. 

Tube-pressure, 50 mm.; blood-pressure, 155 mm.; 
cranial presure, 55 mm. 

Tube-pressure, o mm. ; blood-pressure, 1 20 mm. ; 
cranial pressure, 20 mm. 

Tube-pressure, 47 mm.; blood-pressure, 155 mm.; 
cranial pressure, 55 mm. 

Tube-pressure, 22 mm.; blood-pressure, 152 mm.; 
cranial pressure, 38 mm. 

Tube-pressure, o mm. ; blood-pressure, 1 30 mm. ; cra- 
nial pressure, 20 mm. 

As the pressure increased, the normal stroke of 10 
mm. decreased to an irregular line. When the press- 
ure was rapidly reduced the blood-pressure fell, the 
stroke increasing to the normal 10 mm, but when 
reducing the pressure slowly, the blood-pressure re- 
mained high, the strokes increasing in size until nor- 
mal conditions were again established. 

Experiment 162. 
Pneumatic Pressure. 

Male mongrel dog; good condition; weight, twelve 
kilos. Morphin and ether anesthesia. 
The preliminary blood-pressure was taken in the ca- 
rotid artery. 

13 



ON THE BLOOD-PRESSURE IN SURGERY. 



Blood-pressure, 150 mm.; pulse, 164. 

The cranial bag was placed at 22 mm. 

Both common carotids were ligated. 

A rise of 25 mm. in the blood-pressure followed ; no 

change was recorded in the cranial bag. The animal 

was subjected to pneumatic pressure in the tube. 



c 



D 




Fig. 35. — Exp. 162. — Normal animal, with both carotid arteries ligated, sub- 
jected to an increased atmospheric pressure. A, tube pressure; B, carotid 
pressure ; C, intracranial pressure ; seconds. It will be noted that the general 
arterial pressure rose proportionately higher than the intracranial. The effect 
of this divergence is presumably to increase the determination of the blood 
to the brain. This experiment also shows that the increased intracranial 
pressure responding to the increase in the general pressure is but little, if at 
all, dependent upon the carotid circulation. 



Tube-pressure, 75 mm. ; blood-pressure, 220 mm. ; 
cranial pressure, 70 mm. 

Tube-pressure, o mm.; blood-pressure, 150 mm.; 
cranial pressure, 20 mm. 

Tube-pressure, 75 mm.; blood-pressure, 210 mm.; 
cranial pressure, 70 mm. 

Tube-pressure, 70 mm. ; blood-pressure. 1 50 mm. ; 
cranial pressure, 20 mm. 

At the conclusion of this experiment the intracranial 
pressure recorded a fall of 2 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



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196 ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 163. 

Effect of Increased Atmospheric Pressure upon the 
Intracranial Circulation. 

Male dog; Morphin and ether anesthesia. 
Tube-pressure, o mm. ; blood-pressure, 150 mm. ; cra- 
nial pressure, o mm. ; abdominal pressure, o mm. 

At 2.22, tube-pressure, 100 mm. ; blood-pressure, 260 mm. ; cra- 
nial pressure, 80 mm. ; abdominal pressure, 100 mm. 

At 2.24, tube-pressure, o mm. ; blood-pressure, 150 mm.; cra- 
nial pressure, o mm. ; abdominal pressure, o mm. 

At 2.26, tube-pressure, 240 mm. ; blood-pressure, 60 mm. ; cra- 
nial pressure, 120 mm. ; abdominal pressure, 180 mm. 

At 2.27, tube-pressure, o mm. ; blood-pressure, 150 mm.; cra- 
nial pressure, o mm. ; abdominal pressure, o mm. 

At 2.28, tube-pressure, o mm.; blood-pressure, 150 mm.; cra- 
nial pressure, o mm. ; abdominal pressure, o mm. 

At 2.30, tube-pressure, 1 20 mm. ; blood-pressure, 260 mm. ; cra- 
nial pressure, 60 mm. ; abdominal pressure, 140 mm. 

At 2.32, tube-pressure, o mm.; blood-pressure, 150 mm.; cra- 
nial pressure, o mm. ; abdominal pressure, o mm. 

At 2.38, tube-pressure, 240 mm. ; blood-pressure, 90 mm. ; cra- 
nial pressure, 100 mm. ; abdominal pressure, 170 mm. 

At 2.50, tube-pressure, o mm. ; blood-pressure, 150 mm.; cra- 
nial pressure, 5 mm. ; abdominal pressure, o mm. 

At 3.02, tube-pressure, 360 mm. ; blood-pressure, 220 mm. ; 

cranial pressure, 240 mm. ; abdominal pressure, 250 
mm. 

At 3.10, tube-pressure, o mm. ; blood-pressure, 130 mm.; cra- 
nial pressure, o mm. ; abdominal pressure, o mm. 

At 3.40, tube-pressure, 400 mm. ; blood-pressure, 500 mm. ; 

cranial pressure, 500 mm. ; abdominal pressure, 340 
mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 164. 

On the Effect of Atmospheric Pressure upon the 
Intracranial Pressure. 

Male dog; weight, thirty-two kilos. Morphin and 
ether anesthesia. 

At 9.20, tube-pressure, o mm. ; blood-pressure, 140 mm. ; intra- 
cranial pressure, o mm. 

At 9.30, tube-pressure, 100 mm. ; blood-pressure, 250 mm.; in- 
tracranial pressure, 40 mm. 

At 9.35, tube-pressure, o mm.; blood-pressure, 140 mm.; in- 
tracranial pressure, o mm. 

At 9.40, tube-pressure, 160 mm. ; blood-pressure, 300 mm.; in- 
tracranial pressure, 130 mm. 

At 9.50, tube-pressure, o mm. ; blood-pressure, 150 mm.; intra- 
cranial pressure, 10 mm. 

At 10.00, tube-pressure, o mm. ; blood-pressure, 150 mm.; in- 
tracranial pressvire, o mm. 

At 10.05, tube-pressure, 100 mm.; blood-pressure, 260 mm.; 
intracranial pressure, 36 mm. 

At 10.15, tube-pressvtre, 160 mm.; blood-pressure, 130 mm.; 
intracranial pressure, 134 mm. 

At 10.20, tube-pressure, o mm. ; blood-pressure, 150 mm.; in- 
tracranial pressure, 10 mm. 
The animal was killed. 

Experiment 165. 

Shock. Effect of Variation in Atmospheric Pressure upon 
the Circulation in the Several Cavities of the Body. 

Male dog ; weight, thirteen kilos. Morphin and ether 
anesthesia. 

The apparatus was arranged as in the previous ex- 
periment. 

Preliminary blood-pressure, 130 mm. The animal 
was reduced to a moderate degree of surgical shock. 



198 



ON THE BLOOD-PRESSURE IN SURGERY. 



Blood-pressure, 105 mm. ; abdominal pressure, o 
mm. ; thoracic pressure, o mm. ; cranial pressure, 
o mm. 

The animal was subjected to 90 mm. pressure in the 
tube. 

Blood-pressure was 195 mm. ; abdominal pressure, 88 
mm. ; thoracic pressure, 80 mm. ; cranial pressure, 
50 mm. 

The pressure in the tube was released. 
Blood-pressure, 100 mm.; abdominal pressure, o 
mm. ; thoracic pressure, o mm. ; cranial pressure, o 
mm. 

The animal was killed. 

Experiment 166. 

On the Effect of Varying Atmospheric Pressure upon the 
Circulation in the Various Positions of the Body when 
the Animal is in Shock. 

Male dog; twenty kilos. Morphin and ether anes- 
thesia. 

The apparatus was arranged for simultaneous tracing 
of the blood-pressure, the intrathoracic pressure, and 
the intracranial pressure. 
Normal blood-pressure, 1 20 mm. 
The intracranial bag was subjected to 44 mm. press- 
ure prior to the experiment. The intrathoracic press- 
ure was 18 mm. 

The pressure in the tube was raised to 150 mm. 
Blood-pressure, 220 mm.; thoracic pressure, 136 
mm.; cranial pressure, 130 mm. 
The pressure in the tube was released. 
Blood-pressure, 120 mm.; intracranial, 34 mm; tho- 
racic pressure, 18 mm. 

The absolute rise of the blood-pressure was 100 mm. ; 
of the cranial pressure, 86 mm. ; of the thoracic press- 
ure, 118 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



199 



The dog was then reduced to surgical shock. 
Blood-pressure, 70 mm. 

In raising the tube-pressure to 80 mm. the blood- 
pressure rose. 

Blood-pressure, 140 mm.; cranial pressure, 25 mm.; 
thoracic pressure, 60 mm. 



Fig. 37. — Exp. 166. — On the effect of increased atmospheric pressure in moderate shock. 
A, carotid pressure; intrathoracic pressure; C, intracranial pressure. The net change 
in the circulation was not appreciable. 

Pressure in the tube was released. 

Blood-pressure, 65 mm. ; cranial pressure, o mm. ; 

thoracic pressure, o mm. 

The intracranial pressure curve recorded the pulse 
and the respiratory wave. 



Experiment 167. 

Showing the Effect of communicating the Pulmonary Tract 
with the Pressure Tube, the Animal remaining Outside. 

Mongrel dog ; good condition ; weight, twenty-two 
kilos. Morphin and ether anesthesia. The dog was 
outside of the tube. The carotid cannula was con- 
nected with the manometer. 
At 10.35, blood-pressure, 130 mm.; pulse, 180; respiration, 20. 

The pressure in the tube was increased to 150 mm. 
and the tracheal tube was connected with the com- 



I 



200 



ON THE BLOOD-PRESSURE IN SURGERY. 



pression tube. The stop-cock was opened, and air 
suddenly admitted into the trachea. There was a 
shght leak in the trachea. The blood-pressure fell to 
50 mm. The lungs ruptured, the blood-pressure rose 
slightly, then fell to 30 mm. The pulse, which had 
temporarily ceased, again resumed action. 




Fig. 38. — Exp. 167.— .4, blood-pressure; B, tube-pressure. The tracheal cannula was 
connected with the tube in which there were 150 mm. air-pressure. Note the sudden fall 
in blood-pressure and death. The cause of this fall was the increase of the pressure within 
the alveoli of the lungs until it was higher than the pressure within the capillaries in the 
walls of the alveoli, causing a complete arrest of the circulation at this point. 



At 10.42, blood-pressure, 45 mm. ; pulse, 30 ; respiration 
ceased. 

The dog died from failure of respiration. 
Autopsy. — Rupture of the right lung was found ; both lungs 
contained much air ; the pulmonary vessels were con- 
gested ; the heart was distended and in diastole. The 
blood-vessels of the splanchnic area were enormously 
distended. The posterior peritoneum was forced 



ON THE BLOOD-PRESSURE IN SURGERY. 



Upward among the intestines, and a large quantity 
of air was beneath. The air came from the ruptured 
lung and dissected downward into the abdominal cav- 
ity, behind the peritoneum, having followed the right 
crus in its course through the diaphragm. The dog 
had but one testicle in the scrotum ; an undescended 
testicle apparently functional was found. 

Experiment 168. 

n the Effect of Increased Atmospheric Pressure when the 
Blood-Pressure has been reduced by severing the Spinal 
Cord. 

Male mongrel dog; good physical condition. Ether 
anesthesia. 

The blood-pressure cannula was adjusted in the ca- 
rotid. The cord was severed in the upper dorsal 
region. 

The blood-pressure fell to 20 mm. The dog was 
placed in the tube, and on increasing the atmospheric 
pressure 90 mm. the blood-pressure rose to the level 
recorded before the cord was divided. It was main- 
tained there for a period of ten minutes. On re- 
moving the dog from the tube the blood-pressure fell 
to the point it was before the cord was cut. 

Experiment 169. 
Differential Pressures. 

Male mongrel dog; fair condition. 
Blood-pressure cannula was placed in the carotid, the 
respiratory cannula in the trachea, external connec- 
tions having been made. The animal was placed in 
the tube and the atmospheric pressure was increased 
rapidly to 250 mm. The blood-pressure was raised 
so high that it forced the mercury out of the manom- 
eter. Before the animal could be removed from the 
tube it died of hemorrhage. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 170. 
Differential Pressures. 

Male mongrel dog; poor condition; weight, seven 
kilos. The injection of i dram of one per cent, 
solution of morphin was given. Ether anesthesia. 
The animal was placed in the tube and respiration 
was connected with the externa] atmosphere. The 
pressure in the tube was rapidly increased 200 mm. 
Respiration became shallow and labored. The res- 
piratory effect on the blood-pressure was marked. As 
the pressure rose the excursions of the manometer 
became higher and pari passu with the increase of 
the atmosphere in the tube. 

The animal died in ten minutes, the manometer ex- 
hibited enormous excursions, showing the tendency 
to distention of the heart. 
Autopsy. — The splanchnic and somatic areas were cyanotic. 

The heart was distended almost to the point of burst- 
ing. The lungs and the large venous trunks, also the 
pulmonary circulations, were over-distended. 

Experiment 171. 
Differential Pressures. 

Male mongrel dog; weight, six kilos. 
Blood-pressure, 118 mm. 

The animal was placed in the tube and by means of 
a rubber tube and cannula respiration was connected 
with the outside air. 

The atmospheric pressure in the tube was increased 
to 100 mm. The pressure rose pari passu with the 
increase of the atmospheric pressure. Respiration be- 
came shallow and more labored and in a few min- 
utes failed. The heart finally ceased beating, each 
pulsation becoming shorter than the preceding. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Autopsy. — All the vessels within the thorax were enormously 
congested. Other arteries of the body were anemic. 

Experiment 172. 
Differential Pressures. 

Mongrel dog ; good condition ; weight, nineteen 
pounds. 



A 



JS 




Fig. 39. — Exp. 172. — A, arterial pressure; .ff, tube-pressure. In this animal the tracheal 
cannula was connected with the outer air, so that while the remainder of the body was sub- 
jected to the increased pressure in the tube the lungs were subjected to the pressure of the 
outer air only. Note the enormous increase in the pulse-wave and the rapidly failing circu- 
ation. The blood in quantity was driven into the pulmonary system where the pressure 
was lowest. 

Respiratory apparatus connected with the air of the 
room. The pressure in the tube was increased rap- 
idly to 150 mm. The animal died in seven minutes. 



204 



ON THE BLOOD-PRESSURE IN SURGERY. 



the excursions in the manometer becoming- lonsrer 
and longer. The respiratory efifect on the blood- 
pressure was very marked as the atmospheric press- 
ure in the tube was increased. 



A 



B 




Fig. 40. — Exp. 173. — A, aortic pressure ; B, tube-pressure. On increasing the pressure in the 
tube the aortic pressure rose higher than that of the t^be. 

Experiment 173. 

On the Effect of Changes in the Atmospheric Pressure upon 
the Aortic Pressure. 

Bull dog; weight, thirty-five pounds; good condi- 
tion. Morphin and ether anesthesia. A long cannula 
reaching to the aorta was inserted into the carotid. 
At 4.30, blood-pressure, 160 mm. ; tube-pressure, o mm. ; pulse, 
170; respiration, 16. 



ON THE BLOOD-PRESSURE IN SURGERY. 205 

At 4.33, tvibe-pressure, 100 mm.; blood-pressure, 260 mm.; 

pulse, 188; respiration, 14. 
At 4.36, tube-pressure, o mm. ; blood-pressure, 160 mm. ; pulse, 

185; respiration, 16. 
At 4.40, tube-pressure, 120 mm.; blood-pressure, 280 mm.; 

pulse, 148; respiration, 12. A clot developed in the 

cannula. The dog was removed from the tube and 

prepared for another experiment. 

Experiment 174. 

Ligation of both Vertebral and the Carotid Arteries, the 
Animal being then subjected to Varying Atmospheric 
Pressures. 

Male mongrel dog ; good condition ; weight, ten 
kilos. Morphin and ether anesthesia. 
Preliminary blood-pressure, 120 mm.; cranial press- 
ure, 40 mm.; pulse, 100; respiration, 25. 
Both vertebral arteries were ligated as they entered 
the vertebral foramen. 

The pulse-rate was reduced to 96, and the excursion 
to about half the former height. Blood-pressure. 120 
mm. ; respiration, 23. 

The animal was then placed in a pneumatic tube. 
Blood-pressure, 120 mm. ; cranial pressure, 40 mm. 
The left carotid was ligated. 

The blood-pressure rose 10 mm. and the cranial press- 
ure fell 12 mm. ; the falling curve was quite similar 
to an asphyxial curve. Tube-pressure, o mm., blood- 
pressure, 80 mm. The fall was due to manipulation. 
Cranial pressure, 30 mm. 

Tube-pressure, 45 mm. ; blood-pressure, 1 30 mm. ; 
cranial pressure, 38 mm. 

The cranial pressure did not show the usual rise, 
otherwise the phenomena corresponded to previous 
results. This was repeated several times with the 
same result. 



2o6 ON THE BLOOD-PRESSURE IN SURGERY. 



Duration of experiment, two hours and twenty min- 
utes. Blood-pressure at the close of the experiment, 
without the tube-pressure, recorded ii8 mm. 
The dog was in fair condition at the end of the ex- 
periment. 

Experiment 175. 
Comparing Pressure in Various Parts of the Body. 

Female dog; weight, fourteen kilos. Morphin and 
ether anesthesia. 





Fig. 41.— Exp. 175.—,/, tube-pressure; B. blood-pressure; C, abilomiiial pressure; Z>, 
thoracic pressure ; cranial pressure. Animal in moderate shock. Note the corresponding 
changes in the pressures on varying the pressure in the tube. The advantage was in favor 
of the cranial circulation. 



The apparatus was arranged for recording the blood- 
pressure, intracranial pressure, the thoracic, the ab- 
dominal, and the tube-pressure. 
Preliminary blood-pressure, 135 mm. 
The animal was reduced to moderate surgical shock. 
When subjected to a pressure of 90 mm. the pressure 
rose. 

Blood-pressure, 165 mm.; abdominal pressure, 85 



ON THE BLOOD-PRESSURE IN SURGERY. 



207 



mm. ; thoracic pressure, 74 mm. ; cranial pressure, 
30 mm. 





Fig. 42. — Exp. 175 (continued). — ^, pressure in the tube; B, blood-press- 
ure ; C, intraabdominal ; D, intrathoracic ; £, intracranial. This experiment 
was made upon the dead animal, showing the slight relative loss of force in 
the transmission of pressure through the walls of the various cavities. 

On releasing the tube-pressure, blood-pressure, 83 
mm. ; abdominal pressure, o mm. ; thoracic pressure, 
o mm. ; cranial pressure, o mm. 
Respiration and the pulse were recorded upon the 
intracranial curve. 

Experiment 176. 
On the Changes in the Intracranial Circulation. 

Male dog; weight, eighteen kilos. Morphin and 
ether anesthesia. 

At 12.00, tube-pressure, o mm. ; blood-pressure, 140 mm.; in- 
tracranial pressure, o mm. 

At 12.02, tube-pressure, 90 mm. ; blood-pressure, 230 mm. ; in- 
tracranial pressure, 20 mm. 

At 12.10, tube-pressure, 160 mm. ; blood-pressure, lomm. ; in- 
tracranial pressure, 120 mm. 



2o8 ON THE BLOOD-PRESSURE IN SURGERY. 




» 



ON THE BLOOD-PRESSURE IN SURGERY. 209 

At 12.16, tube-pressure, o mm.; blood-pressure, 10 mm.; in- 
tracranial pressure, 10 mm. 

At 12.32, tube-pressure, 120 mm.; blood-pressure, 260 mm.; 
intracranial pressure, 20 mm. 

At 12.36, tube- pressure, 150 mm. ; blood-pressure, 20 mm. ; in- 
tracranial pressure, 15 mm. 

At 12.50, tube-pressure, o mm. ; blood-pressure, 140 mm.; in- 
tracranial pressi:re, 4 mm. 
The dog was killed. 

Experiment 177. 
As in Experiment 176. 

Male mongrel dog; weight, eleven kilos. Morphin 
and ether anesthesia. Intracranial observations. 

At 11.00, tube-pressure, o mm. ; blood-pressure, 120 mm.; in- 
tracranial pressure, o mm. 

At 1 1.05, tube-pressure, 70 mm.; blood-pressure, 72 mm.; in- 
tracranial pressure, 16 mm. 

At 11.06, tube-pressure, o mm. ; blood-pressure, no mm.; in- 
tracranial pressure, o mm. 

At 1 1. 16, tube-pressure, 60 mm. ; blood-pressure, 160 mm. ; in- 
tracranial pressure, 16 mm. 

At 1 1. 19, tube-pressure, o mm. ; blood-pressure, no mm.; in- 
tracranial pressure, o mm. 

At 1 1.23, tube-pressure, 20 mm.; blood-pressure, 80 mm.; in- 
tracranial pressure, 10 mm. 

At 1 1.25, tube-pressure, 100 mm. ; blood-pressure, o mm. ; in- 
tracranial pressure, 80 mm. 

At 1 1.55, tube-pressure, o mm. ; blood-pressure, no mm.; in- 
tracranial pressure, 40 mm. 

Experiment 178. 
As in Experiment 177. 

Mongrel dog ; weight, twenty-one kilos ; good condi- 
tion. Morphin and ether anesthesia. A button of 
bone was removed from the skull and a rubber cork, 
14 



2IO ON THE BLOOD-PRESSURE IN SURGERY. 

through which a tube passed, and on the end of which 
a rubber bag was attached, was connected with the 
manometer. 

Normal pressure, 120 mm.; pulse, 140; cranial press- 
ure, o mm. ; tube-pressure, o mm. 

At 6.20, blood-pressure, 220 mm.; pulse, no; cranial pressure, 
10 mm. ; tube-pressure, 80 mm. 

At 6.30, tube-pressure, iiomm. ; blood-pressure, 240 mm.; in- 
tracranial pressure, 28 mm. 

At 6.35, tube- pressure, 40 mm.; blood-pressure, 180 mm.; in- 
tracranial pressure, 18 mm. 

At 6.45, tube-pressure, 80 mm. ; blood-pressure, 70 mm. ; in- 
tracranial pressure, 42 mm. 

At 6.50, tube-pressure, 120 mm.; blood-pressure, 20 mm.; in- 
tracranial pressure, 75 mm. 

At this point the heart stopped and the animal was 
killed. 

Experiment 179. 

On the Effect of Atmospheric Pressure upon the Circulation 
of the Various Parts of the Body when the Animal is in 
Shock. 

Male dog; weight, eleven kilos. Morphin and ether 
anesthesia. The apparatus was arranged as in the 
previous experiment. 

Preliminary blood-pressure, 122 mm.; pulse, 88; 
respiration, 28. 

The animal was reduced to considerable shock. 
Blood-pressure, 80 mm. ; abdominal pressure, o mm. ; 
thoracic pressure, o mm. ; cranial pressure, 40 mm. 
The cranial bag was placed under the preliminary 
pressure. 

On raising the pressure in the tube to 150 mm. the 
following results were obtained : 
Blood-pressure, 240 mm.; abdominal pressure, 150 
mm. ; thoracic pressure, 140 mm. ; cranial pressure, 
94 mm. 



0 



ON THE BLOOD-PRESSURE IN SURGERY. 211 

On reducing the pressure in the tube to o mm., blood- 
pressure registered 85 mm. ; abdominal pressure, o 
mm. ; thoracic pressure, o mm. ; cranial pressure, 
40 mm. 

The animal was killed. 

Experiment 180. 

As in Experiment 179. 

Dog ; weight, eighteen kilos. Morphin and ether an- 
esthesia. The apparatus was arranged as in the pre- 
vious experiment. 

Preliminary blood-pressure, 135 mm. 
The animal was reduced to moderate shock. 
Blood-pressure, 115 mm.; abdominal pressure, 10 
mm. ; thoracic pressure, 7 mm. ; intracranial press- 
ure, 16 mm. 

The tube-pressure was reduced to 70 mm. 
Blood-pressure, 160 mm. ; abdominal pressure, 60 
mm. ; thoracic pressure, 70 mm. ; cranial pressure, 
50 mm. 

On removing the pressure the dog died. 
Upon reapplying 100 mm. pressure to the dead ani- 
mal the results were as follows : 
Blood-pressure, 100 mm.; abdominal pressure, 105 
mm. ; thoracic pressure, 85 mm. ; cranial pressure, 
50 mm. 

On releasing the tube-pressure the manometer re- 
corded o mm. 

Experiment 181. 
On the Effect of breathing Rarefied Air. 

Male dog ; weight, twelve kilos. Morphin and ether 
anesthesia. The apparatus was arranged for exhaust- 
ing the pvilmonary tract. 
Normal blood-pressure, 150 mm. 
On exhausting the pulmonary tract, by connecting the 



ON THE BLOOD-PRESSURE IN SURGERY. 



ON THE BLOOD-PRESSURE IN SURGERY. 213 

trachea with the tube with a low negative pressure, 
the heart rate was slow, the force and output greatly 
increased, the length of the stroke greatly amplified, 
the blood-pressure curve declined, and the heart in 
a few minutes stopped in diastole. 

Experiment 182. 
Repetition of Experiment 181. 

Male dog; weight fourteen kilos. Morphin and 
ether anesthesia. The apparatus was arranged for 
a negative experiment upon the pulmonary tract. 
Primary blood-pressure, 140 mm. 
On connecting the trachea with the tube, with a low 
negative pressure, the pulse-waves were enormously 
increased, the heart beat slower, and in a few min- 
utes was arrested in diastole. 

Experiment 183. 

Observation of Variations in the Atmospheric Pressure upon 
the Length of the Pulse-Wave. 

Male mongrel dog ; weight six kilos ; fair condition. 
Morphin and ether anesthesia. 

The blood-pressure was taken in the femoral artery. 
Preliminary blood-pressure, 120 mm.; stroke, to 
mm. 

As the pressure in the tube was increased there was 
a decrease in the length of the stroke. 
Tube-pressure, 100 mm.; blood-pressure, 210 mm.; 
stroke, 6 mm. 

Tube-pressure, redviced to o mm. 

Blood-pressure, 120 mm.; length of stroke, 6 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



EXPERIMEKT 184. 

Repetition of Experiment 183. 

Female mongrel dog ; weight, seven kilos ; fair con- 
dition. Morphin and ether anesthesia. 
Preliminary blood-pressure, 130 mm.; length of 
stroke, 8 mm. 

Tube-pressure, 100 mm. ; length of stroke, 4 mm. 
Tube-pressure, o mm.; blood-pressure, 130 mm.; 
length of stroke, 8 mm. 

Experiment 185. 
Asphyxia. Pressure. 

Female mongrel dog; weight, nine kilos; good con- 
dition. Morphin and ether anesthesia. 
Preliminary blood-pressure recorded 128 mm. 
At the closing of the tube the blood-pressure tracing 
resembled an asphyxial curve. 

The increased atmospheric pressure caused no delay 
in the death from asphyxia. 

When opening the tube the dog was found to be dead, 
due to kinking of the respiratory tube. 

Experiment 186. 
Shock. Pressure. 

Male mongrel dog; good condition; weight, fifteen 
kilos. Ether anesthesia. 

Carotid blood-pressure, 125 mm.; femoral pressure, 
123 mm.; tube-pressure, o mm. 
The animal was subjected to shock by the usual 
means, and was then placed in the tube. 
Tube-pressure, 100 mm. ; carotid pressure, 230 mm. ; 
femoral pressure, 228 mm. 

Tube-pressure, o mm.; carotid pressure, 128 mm.; 
femoral pressure, 125 mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 215 

During forty-five minutes the dog was allowed to 
remain in the tube, at the expiration of which time 
the blood-pressure had fallen in the carotid artery to 
80 mm. The pressure from the femoral artery re- 
corded an irregular line. The animal was replaced 
in the tube and subjected to pressure. 
The femoral pressure rose 20 mm. 
The carotid pressure recorded 100 mm. ; tube, 30 
mm. 

The pressure was released. 
Both the carotid and the femoral pressure fell. 
Carotid pressure, 84 mm. ; femoral pressure, 82 mm. ; 
tube-pressure, o mm. 

Carotid pressure, 200 mm.; femoral pressure, 130 
mm.; tube, no mm. 

As the pressure was released from the tube the fem- 
oral pressure was not affected until the tube-pressure 
recorded 80 mm. 

The carotid pressure was 180 mm. The dog was 
then removed from the tube and the femoral artery 
and cannula examined for a clot, none being found. 
Duration of experiment, two hours and fifty-five min- 
utes. 

In this experiment it was noticed that when the dog 
was in partial shock, the femoral and carotid press- 
ures were similar, but when in complete shock the 
femoral stroke was diminished to a wavy line, the 
pressure being the same as the carotid. 

Experiment 187. 
Shock. Pressure. 

Female mongrel dog; good condition; weight, 5.5 
kilos. Ether anesthesia. 

Preliminary carotid blood-pressure, 143 mm.; fem- 
oral blood-pressure, 143 mm. 
The animal was reduced to moderate shock. 



2l6 



ON THE BLOOD-PRESSURE IN SURGERY. 



Tube-pressure, o mm.; carotid blood-pressure, 130 
mm. ; carotid stroke, 20 mm. ; femoral blood-press- 
ure, 130 mm.; femoral stroke, 18 mm. 
Tube-pressure, no mm. ; carotid blood-pressure, 240 
mm. ; carotid stroke, 20 mm. ; femoral blood-press- 
ure, 240 mm.; femoral stroke, 16 mm. 
Tube-pressure, o mm. ; carotid blood-pressure, 115 
mm. ; carotid stroke, 20 mm. ; femoral blood-press- 
ure, 115 mm.; femoral stroke, 18 mm. 
Tube-pressure, 104 mm. ; carotid blood-pressure, 230 
mm. ; carotid stroke, 20 mm. ; femoral blood-press- 
ure, 230 mm. ; femoral stroke, 16 mm. 
Tube-pressure, o mm.; carotid blood-pressure, 120 
mm.; carotid stroke, 120 mm.; femoral blood-press- 
ure, 120 mm.; femoral stroke, 18 mm. 
The animal was removed from the tube and reduced 
to a greater degree of shock. 

Carotid blood-pressure, 86 mm. ; femoral blood- 
pressure, 86 mm. ; carotid stroke, 10 mm. ; femoral 
stroke, an irregular line. No clot was found in the 
femoral artery. The animal was replaced in the tube. 
Tube-pressure, o mm. ; carotid blood-pressure, 96 
mm. ; carotid stroke, 20 mm; ; femoral blood-press- 
ure, 94 mm. ; femoral stroke, irregular line. 
Tube-pressure, 100 mm. ; carotid blood-pressure, 195 
mm. ; carotid stroke, 10 mm. ; femoral blood-press- 
ure, 109 mm. ; femoral stroke, irregular line. 
Tube-pressure, o mm. ; carotid blood-pressure, 96 
mm.; carotid stroke, 10 mm.; femoral blood-press-, 
ure, 94 mm. ; femoral stroke, irregular line. 
The dog was removed from the tube, no clots being 
found in the cannula. It was observed that the fem- 
oral pressure did not rise synchronously with the 
carotid pressure, or as the tube-pressure was in- 
creased. Similar phenomena were observed when the 
pressure was released. The strokes of the carotid 
were slightly reduced when subjected to pressure, 
while the femoral strokes were obliterated. 



ON THE BLOOD-PRESSURE IN SURGERY. 217 

Experiment 188. 

the Effects of Variation in Pressure upon the Length of 
Pulse- Wave in the Carotid and Femoral Arteries. 

Female mongrel dog; good condition; weight, 

twelve kilos. Ether anesthesia. 

Preliminary blood-pressure in the carotid, 100 mm. ; 

stroke, 8 mm. ; femoral blood-pressure, 99 mm. ; 

stroke, 10 mm. The animal was reduced to moderate 

shock. 

Carotid blood-pressure, 90 mm. ; stroke, 10 mm. 
Femoral blood-pressure, 89 mm. ; stroke, 10 mm. 
The intestines and denuded surfaces were again ma- 
nipulated to obtain a greater degree of shock. Ca- 
rotid blood-pressure, 40 mm. ; femoral blood-press- 
ure, 36 mm. 

The animal was placed in a tube and subjected to 
pressure. 

Tube-pressure, 100 mm. ; carotid blood-pressure, 140 
mm.; stroke, 10 mm.; femoral blood-pressure, 128 
mm. ; stroke, 4 mm. 

Femoral blood-pressure did not rise parallel with the 
carotid pressure, the strokes being diminished to a 
heavy irregular line. When the pressure in the tube 
was released the femoral blood-pressure was several 
millimetres lower than the carotid pressure. 

Experiment 189. 
Repetition of Experiment 188. 

Male dog ; good condition ; weight, nine kilos. Ether 
anesthesia. 

Preliminary blood-pressure in the carotid, 105 mm. ; 
stroke, 4 mm. ; femoral blood-pressure, 104 mm. ; 
stroke, 5 mm. 

The animal was reduced to shock. 

Carotid blood-pressure, 95 mm. ; stroke, 3 mm. ; 



ON THE BLOOD-PRESSURE IN SURGERY. 



femoral blood-pressure, 94 mm. ; stroke, i mm. 
The animal was subjected to pressure in the tube. 
Tube-pressure, 130 mm.; carotid blood-pressure, 236 
mm. ; stroke, 4 mm. ; femoral blood-pressure, 235 
mm. The stroke was somewhat irregular. The 
pressure in the tube was reduced to o mm. 
The carotid blood-pressure, 100 mm. ; femoral blood- 
pressure, 99 mm. 

The pressure experiment was repeated, the femoral 
showing an irregular line. There was no irregularity 
when subjected to pressure. 

The femoral pressure did not rise parallel to the ca- 
rotid pressure, a slight lagging being characteristic. 

EXPEKIMENT 190. 

n the Mechanical Support of the Circulation. 

The following experiments were made to determine 
whether or not the application of pressure upon the 
extremities and trunk would, in cases of shock, raise 
the blood-pressure. If the pressure were raised, 
would it be sustained, and would the application of 
pressure be accompanied by injurious side effects. 

EXPEEIMENT 191. 

Mongrel dog; weight, twenty-one kilos. Morphin 
and ether anesthesia. 

Preliminary blood-pressure recorded 130 mm. 
The animal was reduced to shock by the usual 
method. 

Blood-pressure, 70 mm. 

Pressure with the hands was then applied upon the 
abdomen. A rise in the blood-pressure followed. 
Compensation soon occurred, the pressure falling to 
the previous level. 

On repeating the pressure, a similar effect was noted. 
Grasping one or more paws firmly with the hands 



ON THE BLOOD-PRESSURE IN SURGERY. 219 

was followed by a rise in the blood-pressure, in pro- 
portion to the pressure exerted, and to the number of 
paws compressed. Compensation soon occurred, and 
the blood-pressure returned to the former level. Rub- 
ber elastic bandages were then applied over the ex- 
tremities, the head, the neck, the abdomen, and the 
thorax. The blood-pressure rose from 70 mm. to 
102 mm. as the bandages were applied. 
Dyspnoea became very marked, and the contents of the 
stomach were discharged. The blood-pressvire was 
maintained at the level to which it was raised, so 
long as respiration was not interfered with to a dan- 
gerous degree. It was so apparent that the animal 
would die of asphyxia that the thoracic bandages 
were released. 

The animal was then killed. 

Experiment 192. 
Differential Pressure. 

Male mongrel dog; good condition; weight, twenty 
kilos; 15 milligrams of morphin were injected. 
Ether anesthesia. 

The tracheal and carotid cannula were inserted. The 
dog was reduced to deep shock by skinning, crush- 
ing, and burning, after which he was placed in the 
pressure-tube. The tracheal cannula was connected 
with an external air-chamber in which the pressure 
was maintained 10 mm. below that of the tube. It 
was so arranged that simultaneous tracings of the 
blood-pressure, the tube-pressure, and the respiratory 
pressure could be taken. AA'hen the pressure in the 
tube was raised the blood-pressure rose proportion- 
ately. The excursions of the writing style were in- 
creased from 10 to 40 mm. in length. By changing 
the pressure in the respiration chamber and the tube 
the length of the pulse-wave could be varied. The 



220 



ON THE BLOOD-PRESSURE IN SURGERY. 



heart, however, beat irregularly, with a varying 
rhythm. The dog was then removed from the tube, 
a cannula introduced into the femoral vein and con- 
nected with a burette. Curare, normal saline, and 
adrenalin, i to 100,000, were injected. Artificial 
respiration was supplied. The blood-pressure rose to 
1 30 mm, and was there maintained. On decapitating 
the animal the pressure fell to 30 mm., remaining at 
that level for seventeen minutes, during which ad- 
renalin and saline solution were continuously injected. 
At the end of seventeen minutes artificial respiration 
was discontinued and the heart beat for two minutes. 

Experiment 193. 

Male spaniel ; fair condition ; weight, ten kilos. 

Morphin and ether anesthesia. 
At 10.40, pulse, 144; respiration, 136. 
At 10.50, pulse, 80; respiration, 20. 

At 1 1. 00, pulse, 116; respiration, 28; blood-pressure, 120 mm. 

At 11.02, the animal was placed in the tube. 

At 1 1.04, tube-pressure, 100 mm.; blood-pressure, 140 mm. 

At 1 1.08, tube-pressure, o mm.; blood-pressure, 120 mm.; 
pulse, 106; respiration, 20. 

At 1 1. 10, tube-pressure, o mm.; blood-pressure, 120 mm.; 
pulse, 106; respiration, 20. 

At 1 1. 13, the animal was removed from the tube and the cord 
was severed in the dorsal region. 

At 1 1. 1 5, the blood-pressure fell to 90 mm. 

At 1 1.20, tube-pressure, o mm. ; blood-pressure, 65 mm. ; pulse, 
128; respiration, 28. 

At 1 1.30, blood-pressure slowly rose to 80 mm. and was sus- 
tained. 

At 11.33, the animal was replaced in the tube. 
At 1 1.35, tube-pressure, o mm. ; blood-pressure, 70 mm. ; pulse, 
140; respiration, 24. 

The pulse was weak and the excursions small. 



ON THE BLOOD-PRESSURE IN SURGERY. 22I 

At 1 1.37, tube-pressure, 80 mm.; blood-pressure, 140 mm.; 

pulse, 128; respiration, 24. 
At 1 1.39, tube-pressure, o mm. ; blood-pressure, 80 mm. ; pulse, 

132; respiration, 36. 

The respiratory waves in the blood-pressure tracings 
were very marked. The pulse was of a vagal type, 
and the heart was markedly weakened. 

At 1 1.42, the dog was removed from the tube and found to 
be dying. Artificial respiration and sciatic stimula- 
tion failed. 
The animal died. 

Autopsy. — The intestines were contracted, and the vessels of 
the splanchnic area were dilated. The bladder was 
distended, and the stomach contained about. one hun- 
dred c.c. of fluid. The lungs were pale, the heart 
empty, having stopped in systole. The heart was 
smaller than normal and the walls were very thin. 
During the experiment the dog bled profusely from 
the vertebral artery, severed while cutting the cord. 
Blood was found in the spinal canal. 

Experiment 194. 

Male mongrel dog; good condition; weight, 7.45 
kilos. Morphin and ether anesthesia. 
At 10.18, pulse, 168; respiration, 60. 

At 10.32, pulse, 208; respiration, 40. The blood-pressure ma- 
nometer was connected with the carotid artery, and 
the apparatus for taking the respiratory tracing was 
applied. 

The animal was placed in the tube.' 
At 10.40, tube-pressure, o mm.; blood-pressure, no mm.; 

pulse, 180; respiration, 50. 
At 10.50, tube-pressure, 50 mm.; blood-pressure, 170 mm.; 

pulse, 200; respiration, 36. 
At 10.54, tube-pressure, 75 mm.; blood-pressure, 190 mm.; 

pulse, 176; respiration, 44. 



222 ON THE BLOOD-PRESSURE IN SURGERY. 




ON 'THE BLOOD-PRESSURE IN SURGERY. 223 

At 10.55, tube-pressure, ^^S mm-; blood-pressure, 220 mm.; 

pulse, 180 ; respiration, 60. 
At 10.57, tube-pressure, o mm.; blood-pressure, no mm.; 

pulse, 176; respiration, 40. 

The animal was removed from the tube and the cord 

exposed and severed in the upper dorsal region. The 

animal was then replaced in the tube. 
At 1 1.37, tube-pressure, o mm. ; blood-pressure, 90 mm. ; pulse, 

180; respiration, 36. 
At 1 1.43, tube-pressure, o mm. ; blood-pressure, 90 mm. ; pulse, 

124; respiration, 36. 
At 1 1.45, tube-pressure. 20 mm.; blood-pressure, no mm.; 

pulse, 126; respiration. 28. 
At 1 1.49, tube-pressure, 50 mm.; blood-pressure, 150 mm.; 

pulse, 120; respiration, 36. 
At 1 1. 5 1, tube-pressure, 100 mm.; blood-pressure, 200 mm.; 

pulse, 126; respiration, 36. 
At 1 1.54, tube-pressure, 125 mm.; blood-pressure, 220 mm.; 

pulse, 125; respiration, 30. 
At 1 1.56, tube-pressure, o mm. ; blood-pressure, 90 mm. ; pulse, 

126; respiration, 36. The animal was removed from 

the tube and 710 c.c. of normal saline solution was 

injected into the peritoneal cavity. 
At 12.23, blood-pressure, 9° mm.; pulse, 150; respiration, 24. 
At 12.30, the animal was replaced in the tube. 
At 12.33, tube-pressure, o mm; blood-pressure, 100 mm.; 

pulse, 136; respiration, 24. 
At 12.35, tube-pressure, 25 mm.; blood-pressure, 140 mm.; 

pulse, 138; respiration, 24. 
At 12.38, tube-pressure, 100 mm.; blood-pressure, 190 mm.; 

pulse, 138; respiration, 24. 
At 12.40, tube-pressure, 75 mm. ; blood-pressure, 160 mm. 
At 12.41, tube-pressure, o mm. ; blood-pressure, 90 mm. 
At 12.45, tube-pressure, 25 mm.; blood-pressure, no mm.; 

pulse, 140; respiration, 24. 
At 12.50, the air was changed, and the blood-pressure rose. 

Blood-pressure, no mm.; pulse, 140; respiration, 

28. 



224 '^^E BLOOD-PRESSURE IN SURGERY. 

At 1.06, the air was changed. 

Blood-pressure, 110 mm.; pulse, 140; respiration, 
32. 

At 1. 1 5, the air was changed. 

Blood-pressure, no mm.; pulse, 136; respiration, 
24. 

At 1.25, tube-pressure, o mm. ; blood-pressure, 80 mm. ; pulse, 

136; respiration, 28. 
At 1.26, tube-pressure, 30 mm.; blood-pressure, no mm. 
At 1.35, the air was changed. 

At 1.36, tube-pressure, o mm.; blood-pressure, 75 mm.; pulse, 

144; respiration, 20. 
At 1.46, the air was changed. 

At 1.47, tube-pressure, 40 mm.; blood-pressure, 120 mm.; 

pulse, 144; respiration, 24. 
At 2.00, tube-pressure, o mm. ; blood-pressure, 75 mm. ; pulse, 

134; respiration, 24. 
At 2.02, tube-pressure, 40 mm.; blood-pressure, 120 mm.; 

pulse, 136; respiration, 24. 
At 2.12, tube-pressure, o mm.; blood-pressure, 70 mm.; pulse, 

124; respiration, 22. 
At 2.15, tube-pressure, 40 mm. blood-pressure, 120 mm.; 

pulse, 120; respiration, 24. 
At 2.30, the air was changed; tube-pressure, 40 mm.; blood- 
pressure, 120 mm. 
At 2.45, the tube was opened and the animal appeared to be in 

good condition. 

At 2.48, respiration became spasmodic and the blood-pressure 
gradually fell. 

At 2.50, blood-pressure, 50 mm.; pulse, 52. The pulse was 
vagal. The excursions were large. Respiration, 
spasmodic. The heart became slower and respiration 
ceased. 

Autopsy. — The intestines were pale and much contracted. The 
large mesenteric vein was much engorged ; bladder 
was distended and contained 95 c.c. of fluid ; spleen, 
normal ; kidneys, normal ; liver, somewhat paler than 



ON THE BLOOD-PRESSURE IN SURGERY. 



normal; gall-bladder, quite full; the stomach con- 
tained 125 c.c. of fluid. The heart was distended and 
had stopped in diastole ; the lungs and thoracic veins 
were congested. The inferior and superior vena cava 
and the right heart were distended with venous blood. 
There was injected 710 c.c. of fluid, of which 620 
c.c. was recovered, therefore 90 c.c. was absorbed. 

Experiment 195. 

Mongrel dog; good condition. Ether anesthesia. 
The blood-pressure cannula was adjusted in the ca- 
rotid ; the respiratory cannula in the trachea. 
The dog was placed in the tube and subjected to .9 
kilos pressure. The respiratory cannula was con- 
nected with the external air. On increasing the at- 
mospheric pressure in the tube the blood-pressure rose 
synchronously with the strokes of the piston of 
the air-pump. The pressure was sustained for a few 
moments when it was noted that the heart was beat- 
ing slowly and exhibiting enormous curves. No re- 
spiratory apparatus having been supplied, respira- 
tion soon ceased, and the animal died of asphyxia. 

Experiment 196. 

Mongrel dog; good condition. Ether anesthesia. 
Blood-pressure cannula was adjusted in the carotid 
and the respiratory cannula in the trachea. 
The respiratory system did not communicate with the 
outside air, but the animal breathed through the tube. 
Upon increasing the atmospheric pressure in the tube 
the blood-pressure rose proportionately to the in- 
creased atmospheric pressure, as indicated by the 
gauge. The respirations continued without change. 
The excursion of the manometer was slightly dimin- 
ished in length. The frequency of the heart-beat was 
also diminished. The pressure was raised to the 
15 



226 ON THE BLOOD-PRESSURE IN SURGERY. 



greatest possible height, and upon lowering the at- 
mospheric pressure in the tube the blood-pressure 
fell correspondingly. On removing the entire press- 
ure the blood-pressure fell to the height recorded 
before the experiment was begun. 

Experiment 197. 

Mongrel dog; good condition. Ether anesthesia. 
Blood-pressure cannula in the carotid ; respiratory 
cannula in the trachea. 

The cord was exposed and severed in the lower cer- 
vical region. The dog was placed in the tube and 
subjected to a two-pound pressure. An increase in 
the atmospheric pressure was followed by a corre- 
sponding rise in the blood-pressure. On closing the 
cocks the blood-pressure remained at a level. On 
lowering the pressure the blood-pressure fell cor- 
respondingly. 

Experiment 198. 

Mongrel dog; fair condition. Blood-pressure can- 
nula in the carotid; respiratory cannula in the tra- 
chea. The spinal cord was exposed and severed in 
the lower cervical region. The dog was placed in 
the tube and subjected to varying pressure. 
One-half pound caused a rise in the blood-pressure, 
two pounds twice the rise, and two and one-half 
pounds a corresponding increase. When the press- 
ure was lowered half a pound at a time, the blood- 
pressure fell accordingly. 

The animal breathed in the tube, respiration being 
unaffected. The marked fall in the blood-pressure 
was due to the severing of the spinal cord, but was 
easily overcome by the increased atmospheric press- 
ure. The blood-pressure was raised to the height re- 
corded before the severing of the cord and remained 



ON THE BLOOD-PRESSURE IN SURGERY. 227 

steady in that position for half an hour. On re- 
moving the dog from the tube the blood-pressure re- 
mained at the same level it was after section of the 
cord. 

Experiment 199. 
Shock. Pressure. 

Mongrel dog; good condition. Ether anesthesia. 
Blood-pressure cannula in the carotid. The intes- 
tines were exposed and manipulated until the animal 
was in profound shock. 

It was necessary to continue the dissection and ex- 
pose and manipulate the splanchnic area for twenty 
minutes before the blood-pressure was reduced to 42 
mm. At this time respiration became irregular. The 
blood was dark in color and the pressure was rapidly 
declining. 

The animal was immediately placed in the tube, at- 
mospheric pressure was increased, and the blood- 
pressure returned to normal. The animal remained 
in the tube one hour and fifteen minutes. Respira- 
tion was unchanged, and the condition of the animal 
was the same. The intestines were freely exposed 
during this time. 

The animal was removed and killed by bleeding. 

Experiment 200. 
Shock. Pressure. 

Small dog ; fair condition ; ether anesthesia. Blood- 
pressure cannula in the carotid. The animal was 
reduced to profound shock by extensive dissection 
and exposure of the skin and manipulation of the 
stomach and intestines. The blood-pressure was re- 
duced to 24 mm., the animal was gasping and the 
blood was becoming very dark. 
The dog was placed in the tube and the atmospheric 
pressure was increased to one and one-third pounds. 



228 ON THE BLOOD-PRESSURE IN SURGERY. 



which was sufficient to bring the blood-pressure to 
the level recorded at the beginning of the experi- 
ment. The animal remained in the tube two hours. 
When placed in the tube the intestines were livid, 
and upon removal two hours later, they were pale 
red. 

The animal was bled to death. 

Experiment 201. 
Shock. Pressure. 

Mongrel dog ; fair condition ; ether anesthesia ; can- 
nula in the carotid. The blood-pressure was 146 mm. 
The animal was reduced to surgical shock by opening 
the abdomen, exposing and manipulating the intes- 
tines, and removing the integimients. In thirty min- 
utes the blood-pressure was reduced to 50 mm. The 
intestines were extremely livid and congested. The 
blood-pressure was rapidly falling, and recorded 32 
mm. Respiration was shallow and irregular, death 
being imminent. The animal was placed in the tube 
and atmospheric pressure increased. 
The blood-pressure rose to the control, — i.e., 46 mm. 
Five minutes later it recorded 150 mm. 
The animal was allowed to remain in the tube for 
three hours and twenty minutes, at the expiration of 
which time its condition had not changed. Upon 
removal from the tube the intestines appeared to be 
normal. The cyanosis and congestion had entirely 
disappeared. 

The blood-pressure remained as high as the normal 
and the heart beat strongly. 
The animal was killed by bleeding. 
Autopsy. — The brain, spinal cord, heart, and lungs were found 
to be normal. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment W2. 
Shock. Pressure. 

Mongrel dog ; fair condition ; blood-pressure cannula 
in the carotid. External respiration was supplied. 
Two and one-half c.c. of morphin was administered. 
Ether anesthesia. 

Blood-pressure, 155 mm.; pulse, 145. 

The abdomen was opened, the intestines exposed and 

manipulated. 

Blood-pressure, 125 mm. The intestines were livid, 
and the veins enormously congested. The animal 
was placed in a tube and atmospheric pressure was 
increased, after which the blood-pressure rose to 208 
mm. The pulse decreased from 145 to 105, the 
strokes were somewhat lengthened. The animal was 
allowed to remain in the tube one hour and fifteen 
minutes, and upon removal the intestines were found 
to be almost normal in color. 

The blood-pressure continvied at 150 mm. A few 
minutes after removal from the tube the intestines 
increased in lividity and in ten minutes were the 
same color that they were before the animal was 
placed in the tube. 
Autopsy. — The brain, spinal cord, heart, and lungs were found 
to be normal. 

>■ Experiment 203. 
Shock. Pressure. 

Mongrel dog; good condition; weight, 4.5 kilos. 
The blood-pressure cannula was adjusted in the ca- 
rotid, the respiratory cannula in the trachea. 
Five c.c. of one per cent, solution of morphin was 
injected. Ether anesthesia. 
Initial blood-pressure, 160 mm.; pulse, 150. 
At 3.50, the abdomen was opened and the intestines were ma- 
nipulated, becoming livid and congested. 



230 ON THE BLOOD-PRESSURE IN SURGERY. 

At 3.56, resection of the hip-joint was performed. 

At 4. 10, the sciatic nerve was severed and the proximal end 

was mechanically stimulated. 

Respiration failed. 
At 4.13, artificial respiration was supplied. 
At 4. 16, the skin was dissected from the base of the tail to the 

thorax. 

The superficial veins were greatly dilated. 
Blood-pressure was 140 mm. 

At 4. 18, the skin was dissected from the thorax. 

At 4.20, the kidneys and diaphragm were manipulated. 
The blood-pressure fell to 100 mm. 

At 4.27, the brachial plexus was manipulated. The blood- 
pressure fell to 70 mm. 

The pulse was small and irregular and the blood- 
pressure continued to fall. 

At 4.32, the animal was placed in the tube. 

At 4.41, the blood-pressure had increased somewhat, but a cor- 
responding fall followed. 

At 4.42, by increasing the atmospheric pressure the blood-press- 
ure was raised to 160 mm. 

At 4.5 1, the dog was removed from the tube, and the follow- 
ing observations were made. The intestines were 
red, the veins small, the cyanosis and congestion had 
disappeared. No hemorrhage had occurred. 

At 5.00, the animal was replaced in the tube. 
Blood-pressure, 160 mm. ^ 
The animal remained in the tube thirty minutes, 
maintaining an even blood-pressure. 

At 5.30, the dog was removed from the tube; he was in good 
condition, there having been no hemorrhage. 
The animal was killed by bleeding. 

Autopsy. — The heart and lungs were found normal, the dura 
slightly congested, and the brain and cord normal. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 204. 
Shock. Pressure. 

Mongrel dog; poor condition; weight, nine kilos; 
morphin and ether anesthesia. 
Pulse, 123; respiration, 63. 
At 3. 10, the abdomen was opened; the intestines exposed and 
manipulated; the skin dissected from the back, ab- 
domen, and thorax; the sciatic nerve was exposed 
and manipulated. Spasmodic respiration occurred. 
The blood-pressure dropped to 46 mm. 
The animal was placed in the tube, breathing the air 
of the tube. The blood-pressure was raised to 14c 
mm. 

The dog remained in the tube for two hours, after 
which the blood-pressure fell to 68 mm. 
The animal was killed. 
Autopsy. — Negative. 

Experiment 205. 
Shock. Pressure. 

Male mongrel dog; weight, eight kilos. A prelimi- 
nary injection of 4 c.c. of one per cent, solution of 
morphin was given. Ether anesthesia. 
Pulse, 160; respiration, 33 ; blood-pressure, 120 mm. 
The abdomen was opened ; the intestines exposed and 
manipulated ; the skin of the back and thorax dis- 
sected. 

Blood-pressure fell to 70 mm. 

The animal was placed in the tube and subjected to 
• one and one-third pounds pressure. Blood-pressure 
rose to 130 mm., the heart strokes became slightly 
smaller, and the respiratory action was unchanged. 
The animal was allowed to remain in the tube for 
one hour and thirty minutes ; after which it became 
asphyxiated. Upon removal from the tube there fol- 



232 ON THE BLOOD-PRESSURE IN SURGERY. 

lowed an improvement of respiration, the blood- 
pressure fell to 84 mm. The animal was killed. 
Autopsy. — Negative. 

Experiment 206. 
Shock. Pressure. 

Mongrel dog ; fair condition ; weight, fifteen pounds. 
Ether anesthesia; respiration, 60. 
Blood-pressure, 110 mm. 

The abdomen was opened ; the intestines exposed 
and manipulated, and the skin dissected from the 
abdomen, back, and thorax. The sciatic nerve was 
exposed and manipulated. The pulse became greatly- 
accelerated and irregular, the blood-pressure falling 
to 50 mm. 

The animal was placed in a tube and the blood-press- 
ure raised to 120 mm. Asphyxia caused the death 
of the animal. 

Experiment 207. 

On the Effect of Increased Atmospheric Pressure upon Ab- 
sorption of Saline Solution. 

Mongrel dog; good condition; weight, 11.25 kilos. 

Morphin and ether anesthesia. 
At 2.24, 500 c.c. of normal saline solution, 37° C, was injected 

into the subcutaneous tissue of the abdomen. 
At 2.41, the animal was subjected to one and two-thirds pounds 

atmospheric pressure within the tube. 
At 3.1 1, the dog was removed and killed by puncturing the 

heart. 

Autopsy. — An incision was made over the point of injection 
and the skin was laid back from each side. The tis- 
sues were somewhat anemic. No hemorrhage oc- 
curred on cutting through the skin. The subcuta- 
neous tissue was translucent and boggy. 
Four hundred and twenty-five c.c. of saline were 
recovered, 75 c.c. having been absorbed. 



ON THE BLOOD-PRESSURE IN SURGERY. 233 

Experiment 208. 
Absorption. Pressure. 

Mongrel dog; poor condition; weight, ten kilos. 
Morphin and ether anesthesia. 

At 10.25, the <^ord was exposed in the second dorsal area. 
Blood-pressure, no mm. 

At 10.32, the cord was divided, the blood-pressure falling from 
126 mm. to 100 mm. The heart was weak and respi- 
ration shallow. 

At 10.33, 125 c.c. of saline solution at 25° C. were injected 
into the peritoneal cavity, the blood-pressure falling 
to 66 mm. 

At 10.36, the dog was subjected to one and one-half pounds 
pressure. 

Blood-pressure, 100 mm. ; the heart, very weak. 
At 10.40, the animal died. 

Blood-pressure, 40 mm. 

Death was due to respiratory failure. 

Experiment 209. 

The Effect of Pressure upon Absorption of Fluids when the 
Spinal Cord has been severed. 

Mongrel dog ; fair condition ; weight, fourteen kilos. 
Morphin and ether anesthesia. 

The cord was severed between the second and third 

dorsal vertebrae. 
At 10.43, pulse, 132; respiration, 24. 

An injection of 875 c.c. of saline solution at 25° C. 

was made into the peritoneal cavity. 
At 1 1.05, the animal was placed in the tube and subjected to 

one and one-half pounds pressure. The air was re- 
newed every ten minutes. 
At 12.40, the dog was removed in good condition. 

Pulse, 100; respiration, 18. 

The animal was killed by puncturing the heart. 



234 ON THE BLOOD-PRESSURE IN SURGERY. 

Autopsy. — The intestines were constricted, the gall and uri- 
nary bladders were not distended. Forty c.c. of fluid 
were found in the stomach, which was otherwise nor- 
mal. Eight hundred c.c. of fluid were recovered, the 
absorption being about 35 c.c. 

Experiment 210. 
Preceding Experiment repeated. 

Mongrel dog; good condition; weight, 7.2 kilos. 

Morphin and ether anesthesia. 

Pulse, 150; respiration, 35. 
At 2.25, the cord was exposed and divided in the dorsal region. 
At 2.27, respiration, 30; pulse, 108, irregular. 
At 2.35, 1450 c.c. of saline solution at 37° C. were injected. 

Pulse, 80; respiration, 23. 
At 2.36, the animal was subjected to one and one-half pounds 

pressure and the air was renewed every ten minutes. 
At 4.40, the dog died of respiratory failure. Fluid escaped 

from the mouth, nose, and anus. The abdomen was 

opened, there was general congestion. The heart was 

distended. Death was probably due to asphyxia. 

Fourteen hundred c.c. of solution were recovered, 

about 50 c.c. having been absorbed. 

Experiment 211. 
Preceding Experiment repeated. 

Bull terrier; good condition; weight, 12.2 kilos. 
Morphin and ether anesthesia. 

Pulse, 66 ; respiration, 30 ; the cord was exposed and 

severed at the third dorsal vertebra. 

Pulse, 138; respiration, 18. 
At 5.02 to 5.16, 1340 c.c. of saline solution at 37° C. were given. 

Pulse, 138; respiration, 24. 
At 5. 18, the animal was subjected to one and one-half pounds 

pressure in the tube, the air being renewed every ten 

minutes. 



ON THE BLOOD-PRESSURE IN SURGERY. 235 

At 6.5 1, the animal was removed from the tube. 
Pulse, 156; respiration, 18. 

The animal was killed by puncturing the medulla. 
Autopsy. — There was slight edema of the subcutaneous tis- 
sues. No fluid was found in the intestines or the 
stomach. The splanchnic vessels were dilated. The 
gall and urinary bladders were empty ; the lungs and 
heart slightly congested. Twelve hundred and sev- 
enty c.c. of the solution were recovered, about 70 c.c. 
having been absorbed. 

Experiment 212. 
Repetition of the Preceding. 

Mongrel dog; good condition; weight, twenty-two 
kilos. Morphin and ether anesthesia. 
Initial blood-pressure, 155 mm.; pulse, 168; respi- 
ration, 30. 

At 2.03, tube-pressure, 2 pounds ; blood-pressure, 260 mm. ; 

pulse, 160; respiration, 22. 
At 2.05, tube-pressure, ij^ pounds; blood-pressure, 230 mm.; 

pulse, 160; respiration, 30. 
At 2.07, tube-pressure, o ; blood-pressure, 150 mm.; pulse, 158. 
At 2.08, the dog was removed from the tube in good condition. 
At 2.32, the cord was severed in the upper dorsal region. 

Blood-pressure, no mm.; pulse, 144; respiration, 

19. 

At 2.44, tube-pressure, i^^ pounds; blood-pressure, 100 mm.; 
pulse, 130 mm.; respiration, 38. 

At 2.48, the animal was removed from the tube. 

At 2.50 to 2.54, 1620 c.c. of saline solution at 37° C. were in- 
jected into the peritoneal cavity. 
Blood-pressure, 100 mm.; pulse, 177; respiration, 
16. 

The animal was replaced in the tube. 
At 3.05, tube-pressure, ^ pound; blood-pressure, 140 mm.; 
pulse, 160; respiration, 20. 



236 ON THE BLOOD-PRESSURE IN SURGERY. 

At 3.08, tube-pressure, i pound; blood-pressure, 150 mm.; 

pulse, 150; respiration, 34. 
At 3. 12, the air was renewed. 

Blood-pressure, 90 mm. ; pulse, 148; respiration, 36. 
At 3.16, tube-pressure, pounds; blood-pressure, 150 mm.; 

pulse, 152; respiration, 18. 
At 3.25, the air was renewed. 

Blood-pressure, 90 mm.; pulse, 140; respiration, 20. 
At 3.26, tube-pressure, pounds; blood-pressure, 150 mm.; 

pulse, 140; respiration, 20. 
At 3.37, the air was renewed. 

Blood-pressure, 80 mm.; pulse, 128; respiration, 20. 
At 3.39, tube-pressure, pounds; blood-pressure, 150 mm.; 

pulse, 122; respiration, 20. 
At 3.45, blood-pressure, 120 mm.; respiration, spasmodic. 
At 3.47, tube-pressure, o; blood-pressure, 50 mm.; respira- 
tion, 9. 

At 3.49, tube-pressure, i pound; blood-pressure, 120 mm. 
At 3.50, the animal was killed. 

Autopsy. — The intestines were empty ; the veins dilated. The 
bladder was not filled ; the stomach was empty. The 
heart was distended and there was no congestion of 
the lungs. Fourteen hundred and seventy c.c. of 
solution were recovered, about 150 c.c. having been 
absorbed. 

Experiment 213. 
Repetition of the Preceding. 

Mongrel dog; good condition; weight, seven kilos. 
Morphin and ether anesthesia. 
At 8.40, pulse, 184, strong, regular, and rhythmic; respiration, 
52. 

At 9.08, pulse, 180, small and regular; respiration, 36. 
At 9.25, the cord was severed in the upper dorsal region. 
At 9.27, pulse, 176; respiration, 22. 

At 9.33, 730 c.c. of normal saline were injected into the ab- 
dominal cavity. 



ON THE BLOOD-PRESSURE IN SURGERY. 237 

At 9.35, pulse, 150; respiration, 52. 
At 9.50, pulse, 200 ; respiration, 24. 

Twitching of the fore-legs and neck was noted. 
At 10.45, pulse, 220; respiration, 24. 
At 1 1. 10, pulse, 196; respiration, 22. 
At 11.35, pulse, 200; respiration, 24. 

At 1. 40, air was forced into the femoral vein, killing the ani- 
mal. 

Autopsy. — There was general vascular congestion of the entire 
splanchnic area. The intestines were contracted ; the 
bladder distended ; veins of the mesentery were very 
greatly congested. The large intestine contained a 
small amount of fluid ; the stomach and ilium con- 
tained about 100 c.c. of fluid, the vessels of the 
kidney were congested ; liver normal ; gall-bladder 
moderately full : the pancreas and the spleen were 
normal ; the A'eins of the diaphragm were dilated. 
The pulmonary vessels were dilated as was also the 
heart and its vessels. There was general congestion 
of the thoracic cavity. The cancellous tissue of the 
skull bled freely when cut. The vessels of the pia 
were congested. The brain, negative. Six hundred 
and fifty-five c.c. of the fluid were recovered, about 
75 c.c. being absorbed. 



EXPERIMEXT Sll. 

Repetition of the Preceding. 

Mongrel dog; good condition; weight, thirteen kilos. 
Morphin and ether anesthesia. 
At 10.05, pulse, 152; respiration, 40. 

At 10. 10, the cord was severed in the upper dorsal region. 

At 10.15, pulse, 118; respiration, 40. 

At 10.20, 1070 c.c. of normal saline were injected. 

At 10.22, pvilse, no; respiration, 30. 

At 10.45, pulse, 168; respiration, 32. 

At 1 1. 1 5, pulse, 118; respiration, 28. 



ON THE BLOOD-PRESSURE IN SURGERY. 



At 12. oo, pulse, 92; respiration, 32. 

At 12.20, pulse, 112; respiration, 24. 

The animal was killed by forcing air into the fem- 
oral vein. 

Autopsy. — General congestion existed in the entire splanchnic 
area. The intestines were contracted ; the stomach 
contained about 120 c.c. of fluid; there was a small 
amount of fluid in the ilium ; the spleen, pancreas, 
and liver were normal ; the gall-bladder and urinary 
bladder were somewhat distended. The thoracic cav- 
ity was congested and the heart distended. Nine 
hundred and ten c.c. of fluid were recovered, about 
160 c.c. having been absorbed. 

Experiment 215. 

On the Rapidity of Subcutaneous Absorption of Saline when 
the Spinal Cord has been severed. 

Dog; fair condition ; weight, fifteen kilos. Morphin 
and ether anesthesia. The respirations were very 
rapid. 

At 10.30, pulse, 152; respiration, 30. 

At 10.36, the cord was severed in the upper dorsal region. 

At 10.38, pulse, 148; respiration, 100. 

At 10.40, 620 c.c. of saline were injected. 

At 10.41, pulse, 140; respiration, 72. 

At 1 1. 1 5, pulse weak and rapid; respiration, 50. 

At 1 1.25, respiration, 58. 

At 12.33, pulse, 128; respiration, 80. 

At 12.35, the animal was killed by an overdose of ether. 

Autopsy: — The subcutaneous tissues were anemic and filled 
with fluid, of which 410 c.c. were recovered and about 
210 were absorbed. General splanchnic congestion 
existed. A small amount of fluid was in the perito- 
neal cavity ; the thoracic cavity was congested and 
the heart distended. 



ON THE BLOOD-PRESSURE IN SURGERY. 239 

Experiment 216. 

On Normal Absorption when the Spinal Cord has been 

severed. 

Mongrel dog ; good condition ; weight, twelve kilos. 
Morphin and ether anesthesia. 
At 10.55, pulse, 124; respiration, 24. 

At 1 1 .00, the cord was severed in the upper dorsal region. 
At 1 1.03, pulse, 140; respiration, 32. 

At 1 1.06, 880 c.c. of saline were injected into the abdominal 
cavity. 

At 1 1.08, pulse, 116; respiration, 24. 

At 12.10, the animal was killed by forcing air into the jugular 
vein. 

Seven hundred and forty c.c. of fluid were recovered; 
about 140 c.c. were absorbed. 

Some Experiments showing the Effect of Increased Atmos- 
pheric Pressure on Hemorrhage. 

Experiment 217. 

Mongrel dog ; weight, ten kilos ; ether anesthesia. 
Cannula in the carotid. 

Blood-pressure, 125 mm. One-fourth grain of mor- 
phin sulphate was administered. 
One hundred and fifty c.c. of blood were drawn. 
Blood-pressure fell to 80 mm. 

The animal was placed in the tube and two-thirds of 
a pound of atmospheric pressure applied. Blood- 
pressure rose to 130 mm. The volume of the pulse 
was not increased. 

Experiment 218. 

Mongrel dog ; weight, eight kilos. Ether anesthesia. 
Three c.c of a one per cent, solution of morphin were 
injected. 

One hundred and eighty c.c. of blood were abstracted 
from the jugular vein. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Blood-pressure fell from 136 mm. to 76 mm. The 
animal was placed in the tube and one pound of at- 
mospheric pressure applied. 

Blood-pressure rose to 140 mm. The volume of the 
pulse was unchanged. 

Experiment 219. 
Hemorrhage. Pressure. 

Dog; good condition; weight, ten kilos. Ether an- 
esthesia. 

Blood-pressure, 121 mm. The animal was bled from 
the jugular vein until no more blood flowed. Death 
was so imminent that the dog was placed with the 
greatest haste in the tube. Atmospheric pressure 
was raised, which in turn raised the blood-pressure. 
Although the manometer excursions could scarcely 
be seen, the blood-pressure was raised to 120 mm. 
and allowed to remain there twenty minutes. The 
heart and respiration during this time remained the 
same. On removing the animal from the tube the 
blood-pressure fell to 26 mm. 
The dog was killed by excessive anesthesia. 

Experiment 220. 
Hemorrhage. Pressure. 

Male mongrel dog ; good condition ; weight, eighteen 
kilos. 

Blood-pressure, 125 mm. The animal was bled until 
there was no longer a flow. Blood-pressure, 30 mm. 
The animal was placed in the tube and atmospheric 
pressure raised, the blood-pi'essure rose proportion- 
ately. The excursions of the writing style indicated 
that the heart-beats continued undiminished for forty- 
five minutes, after which the animal was removed 
and the blood-pressure fell. Respiration was dis- 
tinctly improved. 



I 



ON THE BLOOD-PRESSURE IN SURGERY. 241 

Experiment 221. 
Barometric Effects. 

The following experiments were performed in the 
compression chamber at Lakeside Hospital. 
Male mongrel dog; weight, fifty pounds. Morphin 
and ether anesthesia. 

The carotid was connected with the manometer. 

At 12.15, barometer, 29.6 inches; pulse, 104; respiration, 28; 
blood-pressure, 140 mm. 

At 12.20, the pressure in the chamber was raised. 

At 12.45, barometer, 29.6 inches; pulse, 160; respirations, 40; 

blood-pressure, 140 mm. The blood-pressure excur- 
sions were 6 mm. at each beat. 

At 12.55, barometer, 30.4 inches; pulse, 154; respirations, 40; 
blood-pressure, 140 mm. 

At 1. 1 2, the integument was removed from one side of the 
trunk. 

During the operation the blood-pressure rapidly fell 
to 80 mm., then slowly rose to 120 mm. 

At 1. 1 5, barometer, 30.5 inches; blood-pressure, 120 mm. 

During the manipulation of the skin, the blood-press- 
ure rose to 140 mm. 

At 1.20, the intestines were exposed. 

Barometer, 30.5 inches; pulse, 144; respirations, 50; 
blood-pressure, 120 mm. 

At 1.23, the intestines were manipulated. 
Blood-pressure, no mm. 

The manipulation of the intestines was continued. 
At 1.24, blood-pressure, 90 mm. 

The manipulation was continued. 
At 1.26, blood-pressure, 60 mm. 

The manipulation was continued. 

Hemorrhage from ruptured spleen occurred. 

The spleen was tied off. 

The animal was then killed. 

16 



242 ON THE BLOOD-PRESSURE IN SURGERY. 

Experiment 222. 
Pneumatic Pressure. 

The barometric reading was 29.45 inches in the pneu- 
matic chamber with normal atmosphere. The press- 
ure in the chamber could not be raised above 30.45 
inches by the barometer. That amount of pressure 
was reached in each case two minutes after closing 
the escape-pipe. Air was forced into the chamber 
continuously. With the escape-pipes closed a con- 
stant pressure of one inch above the normal pressure 
could be maintained. The readings of the mercurial 
manometer contain a negative error of 25.7 mm. 
while under maximum pressure, since the free end 
of the mercurial manometer was exposed to the press- 
ure of the chamber. Corrected readings are placed 
in parenthesis following the recorded blood-pressure. 
Male dog ; good condition ; twenty-two kilos. Mor- 
phin and ether anesthesia. 

The carotid was connected with the manometer and 

a tracheal cannula was inserted. 
At 3.25, barometer, 29.45 inches. Blood-pressure, 105 mm.; 

pulse, 180; respiration, 80. 
At 3.28, the pressure was raised. 

At 3.30, barometer, 30.40 inches; blood-pressure, 105 mm. 
(128). 

At 3.45, barometer, 30.45 inches; blood-pressure, 105 mm. 

(130.5); pulse, 184; respiration, 172. 
At 3.55, the pressure was released. 

At 4.00, barometer, 29.45 inches; blood-pressure, 100 mm.; 

pulse, 200; respiration, 80. 
At 4.01, the pressure was raised. 

At 4.05, the intestines were exposed and manipulated. Ba- 
rometer, 30.45 inches; blood-pressure, 80 mm. 
(105.5) ; P"lse, 180. 

At 4.06, barometer, 30.45 inches; blood-pressure, 90 (115. 5); 
pulse, 180. 



4 



ON THE BLOOD-PRESSURE IN SURGERY. 243 

At 4.07, toes and testicles were crushed. Barometer, 30.45 
inches; blood-pressure, 90 mm. (115. 5); pulse, 176; 
respiration, 72. 

At 4. 13, the tail was crushed. Barometer, 30.45 inches ; blood- 
pressure, 90 mm. (115. 5); pulse, 156; respiration, 
76. 

At 4. 15, heavy blows were exerted in the legs. 

At 4. 17, barometer, 30.45 inches; blood-pressure, 80 mm. 

(105.5) '> the fall in the blood-pressure was probably 

due to hemorrhage from the tail. 
At 4.22, barometer, 30.45 inches; blood-pressure, 80 mm, 

(II5-5). 

At 4.24, burning the hind foot was followed by a temporary 

rise to 90 mm. (115.5). 
At 4.25, repetition of burning the foot was followed by some 

temporary rise. 

At 4.26, barometer, 30.45 inches; blood-pressure, 80 mm. 
(105.5); pulse, 148; respiration, 44. 

At 4.27, the penis was crushed and the intestines were manipu- 
lated. 

At 4.30, barometer, 30.45 inches; blood-pressure, 70 mm. 
(95-5)- 

All abdominal organs were disturbed and the peri- 
neum was torn. 

At 4.3 1, ether was poured on the intestines ; the blood-pressure 
fell to 55 mm. (75-5)- 

At 4.32, manipulation of the intestines was continued. Blood- 
pressure, 60 mm. (85.5). 

At 4.33, the intestines were replaced and the abdomen closed. 

At 4.36, barometer, 30.45 inches; blood-pressure, 70 mm. 
(95-5) ; pulse, 192. 

At 4.42, barometer, 30.45 inches ; blood-pressure, 75 mm. 
(105.5); pulse, 198; respiration, 52. 

At 4.44, barometer, 30.45 inches ; blood-pressure, 80 mm. 
(105.5) J the pressure was removed. 

At 4.47, barometer, 29.45 inches ; blood-pressure, 80 mm. ; 
pulse, 204; respiration, 56. 



« 



244 "^^^ BLOOD-PRESSURE IN SURGERY. 

At 4. 5 1, the intestines were exposed; barometer, 29.45 inches; 

blood-pressure, 60 mm. (60) temporary. 
At 4.52, barometer, 29.45 inches; blood-pressure, 80 mm. 

(80). 

After vigorous manipulation of the intestines the 

blood-pressure recorded 70 (70). 
At 4.55, barometer, 29.45 inches; blood-pressure, 75 mm. 

(75); pulse, 204; respiration, 60. 
At 4.56, the pressure was increased. 

At 5.06, barometer, 30.45 inches; blood-pressure, 75 mm. 

(100.5); pulse, 192; respiration, 54. 
At 5.10, barometer, 30.45 inches; blood-pressure, 70 mm. 

(95-5); 

At 5.12, the cartilages of the ear were crushed. 

At 5.13, barometer, 30.45 inches; blood-pressure, 60 mm. 

(85.5)- _ 

At 5. 14, the intestines were manipulated; blood-pressure, 60 
mm. (85.5). 

Manipulation of the intestines was continued. 

At 5.17, the blood-pressure remained steadily at 60 mm. (85.5). 

At 5.18, barometer, 30.45 inches; blood-pressure, 60 mm. 

(85-5) ; pulse, 180; respiration, 54. The intestines 
were manipulated until the end of the experiment. 

At 5. 19, the pressure was removed and the blood-pressure re- 
mained steady at 60 mm. during the escape of air. 

At 5.23, barometer, 25.45 inches; blood-pressure, 60 mm. 
(60) ; pulse, 196. 

At 5.25, the pressure was raised. 

At 5.30, barometer, 30.45 inches; blood-pressure, 60 mm. 

(85.5); pulse, 192; respiration, 52. 
At 5.35, barometer, 30.45 inches; blood-pressure, 50 mm. 

(75-5); pulse, 196; respiration, 148. 
At 5.37, the pressure was removed. 

At 5.39, barometer, 29.45 inches; blood-pressure, 45 mm. 

(45) ; pulse, 200; respiration, 76. 
: The dog was killed. Under pressure the arterial ten- 

sion and the pulse were slower than under normal 



ON THE BLOOD-PRESSURE IN SURGERY. 



atmosphere. The respiration was also slowed and 
strengthened under pressure. The animal was under 
continuous dissection and manipulation. 

Experiment 223. 
Resuscitation. 

Dog ; poor condition ; weight, fourteen kilos. Ether 
anesthesia. 

Initial blood-pressure, 130 mm.; pulse, 148. The 
cord was severed on a level with the second cervical 
vertebra, producing a fall in the blood-pressure to 
the abscissa line. The heart ceased action for fifteen 
seconds, then resumed. The blood-pressure rose to 
135 mm., after which it fell to 80 mm., later declining 
* to 65 mm. 

On injecting ten minims of tincture of digitalis into 
the jugular vein, the pressure rose to 120 mm., after- 
wards falling to 80 mm. 

A repetition of the injection produced a rise to 100 
mm., followed in a few minutes by a fall to 80 mm. 
On injecting ten minims of i to 1000 adrenalin solu- 
tion, the blood-pressure rose to 225 mm., then fell in 
one minute to 35 mm. 
The animal was then killed. 

Experiment 224. 
Resuscitation. 

Dog ; weight, eleven kilos. Ether anesthesia. 
Initial blood-pressure, 140 mm. Clamping the 
trachea caused a rise in the blood-pressure to 150 
mm., then a gradual fall to the abscissa line. 
Through the window in the thorax the heart was 
observed vintil every part of it was quiescent. At the 
expiration of a minute, the clamp was removed, arti- 
ficial respiration was begun, and a continuous infu- 
sion of I to 50,000 of adrenalin into the jugular vein 



246 ON THE BLOOD-PRESSURE IN SURGERY. 



was made. The blood-pressure rose to 180 mm., then 
rapidly fell to 30 mm. On resuming the rhythmic 
pressure of the heart, the blood-pressure rose to 70 
mm. On resumption of the rhythmic pressure, the 
heart beat very slowly, with a feeble and irregular 
contraction. Ten minims of adrenalin, i to 1000, 
were injected into the muscle and a like amount into 
the cavity of the heart. The heart's action increased, 
but after two minutes, irregular twitchings were sub- 
stituted for the rhythmic contractions. The heart 
then passed into delirium cordis. 
Time, thirty-five minutes. 

Experiment 225. 
Resuscitation. , 

Dog; fair condition; weight, sixteen kilos. Ether 
anesthesia. 

Initial blood-pressure, 120 mm. 
At 10.45, the trachea was clamped. A sharp decline in the 

blood-pressure of 20 mm. followed. 
At 10. 50, the animal was apparently dead. There were no 

respirations and no heart beats. 
At 10.59, blood-pressure, 30 mm. 

At 1 1. 00, artificial respiration, rhythmic pressure upon the heart 
through the window in the chest, and a continuous 
infusion of adrenalin, i to 50,000. into the jugular 
vein were begun. The blood-pressure steadily rose 
to 40 mm., when the lieart resumed beating, after 
which the blood-pressure rose sharply to 125 mm. 

At 1 1.03, blood-pressure, 65 mm.; pulse, 120. The animal at- 
tempted normal breathing. The window in the tho- 
rax was closed. Shallow respirations continued a 
short time, then appeared to be normal. 
The animal was killed. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 226. 
Resuscitation. 

Mongrel dog; weight, nine kilos. Ether anesthesia. 
The trachea was clamped. Through a window in 
the thorax the heart was observed until there was not 
even a slight twitching of the auricles. Five minutes 
later, artificial respiration, rhythmic pressure upon 
the heart through the window, and adrenalin were 
supplied. The blood-pressure rose from 20 mm. to 
70 mm., the heart began to beat, but resuscitation 
failed. At autopsy a clot in the heart was found. 

Experiment 227. 
Resuscitation. 

Mongrel dog; fair condition; weight, nine kilos. 
In this case the heart was quiescent for six minutes. 
Pulsations were re-established and the blood-pressure 
rose to 80 mm., but independent strong contractions 
and a maintenance of the blood-pressure could not 
be obtained. 

Experiment 228. 
Resuscitation. 

Mongrel dog ; fair condition ; weight, eight kilos. 
The trachea was clamped. Eight minutes after the 
last beat of the heart artificial respiration, rhythmic 
pressure upon the thorax, and adrenalin were given. 
Respirations and the heart's action were restored. 
The animal was killed. 

Experiment 229. 
Resuscitation. 

Mongrel dog; poor condition, weight, six kilos. 
The trachea was clamped. Ten minutes after the 
last beat of the heart the clamp was removed, and 



ON THE BLOOD-PRESSURE IN SURGERY. 



artificial respiration and pressure upon the thorax 
were begun. The heart executed some contractions, 
but the animal could not be resuscitated. At autopsy 
clots were found in the ventricles. 

Experiment 230. 
Resuscitation. 

Mongrel dog; good condition; weight, ten kilos. 
Ether anesthesia. 

Initial blood-pressure was 115 mm. The animal 
was asphyxiated by clamping the trachea. The blood- 
pressure at the end of four minutes stood at 5 mm. 
After a lapse of ten minutes from the last beat of 
the heart the clamp was removed, artificial respira- 
tions were begun, normal saline infusion was in- 
jected into the jugular vein, and rhythmic pressure 
upon the thorax and abdomen was made. All of 
these measures were continued for four minutes, the 
blood-pressure at no time rising above 25 mm. The 
heart did not beat during nor at the end of this time. 
The blood-pressure fell to 8 mm. 
Adrenalin, i to 50,000, was substituted for the salt 
solution, and the remainder of the technique was re- 
peated in as nearly the same manner as possible. The 
blood-pressure gradually rose, and after two minutes 
the heart evidenced irregular and slow contractions. 
The blood-pressure reached 80 mm., length of stroke, 
28 mm., showing an over-stimulation of the vagal 
terminals in the heart. 

One-fiftieth of a grain of atropin was then adminis- 
tered. Length of stroke, 12. 

Two minutes later the adrenalin was discontinued. 

The blood-pressure had risen to 160 mm. 

Eleven minutes later the blood-pressure was 150 mm., 

and seven minutes later had fallen to 50. The 

strokes were 50 mm. long and the heart's action was 

arrhythmic. 



ON THE BLOOD-PRESSURE IN SURGERY. 249 

The blood-pressure gradually fell to 10 mm., and the 
animal died. 

Experiment 231. 
Resuscitation. 

Mongrel dog; good condition; weight, nine kilos. 
Initial blood-pressure, 125 mm. While clamping the 
trachea, the blood-pressure gradually rose to 200 mm., 
but fell two minutes later to the abscissa line. At 
the end of four minutes the heart, as observed 
through a window in the thorax and on the tracing, 
was completely arrested. After a lapse of five min- 
utes artificial respiration and rhythmic pressure over 
the abdomen was begun. It was observed that the 
blood in the carotid, cannula changed to a red color. 
Adrenalin in i to 50,000 was infused into the jugular 
vein from a height of four feet. The flow at first was 
rapid, then was gradually slowed. The blood- 
pressure slowly rose until it reached 80 mm., when 
slight contractions of the auricular appendages were 
noted. These extended to the ventricles and varied 
in rate of from 60 to 80 per minute. This was fol- 
lowed by a short quiescent period, after which weak, 
slow, and regular contractions were observed. The 
blood-pressure continued to rise, and the infusion of 
adrenalin was gradually diminished. The heart re- 
sumed a normal action and the blood-pressure rose 
to 170 mm., where it remained for five minutes, after 
which it gradually fell to no mm. The respirations 
were re-established and the animal was then killed. 

Experiment 232. 
Resuscitation. 

Mongrel dog ; good condition ; weight, nine kilos. 
Initial blood-pressure, 115 mm. The trachea was 
clamped, and a window made in the thorax. 



ON THE BLOOD-PRESSURE IN SURGERY. 



At the end of five minutes, the entire heart's action 
was arrested, and the blood-pressure was at the 
abscissa Hue. 

Four minutes later artificial respiration was begun,, 
rhythmic pressure was made directly upon the heart, 
and I to 50,000 solution of adrenalin was infused into 
the jugular vein. Fibular contractions were soon 
noted, and later weak rhythmic contractions which 
soon became stronger. The blood-pressure rose to 
100 mm. 

Respirations were re-established. The animal was 
then killed. 

Experiment 233. 
Resuscitation. 

Dog ; good condition ; weight, ten kilos. Ether anes- 
thesia. 

Initial blood-pressure, 125 mm. The trachea was 

clamped, and a window was made in the chest wall 

through which the heart could be observed. 

At the end of three minutes cardiac action had ceased. 

There were no contractions of the auricles, nor could 

any be observed in the large venous trunks near the 

heart. 

Five minutes after cessation of heart's action artificial 
respiration was begun, and through a needle attached 
to a rubber tube i to 50,000 solution of adrenalin 
was injected directly into the left ventricle from a 
height of six feet. The heart became greatly dis- 
tended and pale. The adrenalin was allowed to flow 
for two minutes. No effect upon the heart was 
noted, and but a slight rise in blood-pressure followed. 
The heart- was then gently manipulated; no contrac- 
tions followed. More vigorous pressure upon the 
heart emptied it, but nothing more than fibular con- 
tractions were obtained. The animal could not be 
resuscitated. 



ON THE BLOOD-PRESSURE IN SURGERY. 25 1 

Experiment 234. 
Resuscitation. 

Mongrel dog ; good condition ; eleven kilos. Ether 
anesthesia. 

Initial blood-pressure, 128 mm. The trachea was 
clamped and a window in the thorax was made 
through which the heart was observed until no further 
contractions were noted. 

After three minutes a solution of from i to 50,000 
adrenalin was infused from a height of five feet, by 
means of a needle, into the left ventricle. The ven- 
tricle filled, the heart became paler, but beyond a few 
fibular contractions, no effects were noted. Artificial 
respirations were maintained during the experiment. 

Experiment 235. 
Resuscitation. 

Mongrel dog; good condition; weight, twelve kilos. 
Ether anesthesia. 

Preliminary blood-pressure, 125 mm. The trachea 
was clamped, after which the blood-pressure rose to 
180 mm., then gradually fell to the abscissa line. 
The last heart-beat was noted three minutes after 
clamping the trachea. After the animal had remained 
apparently dead for fifteen minutes the clamp was 
removed from the trachea, rhythmic pressure upon 
the thorax over the heart was begun, adrenalin, i 
to 50,000, was infused into the jugular vein from a 
height of three feet, and artificial respiration was sup- 
plied. The blood-pressure gradually rose, and at the 
end of two minutes the heart began to beat. The 
pulsations were at first weak and slow, then more 
rapid and stronger. The adrenalin was quickly in- 
fused at first, and when the blood-pressure had risen 
to 40 mm. the rate of flow was gradually diminished. 



.1 



ON THE BLOOD-PRESSURE IN SURGERY. 

The total amount used was 200 c.c. The heart did 
not begin to beat until the blood-pressure had risen 
to 75 mm. The blood-pressure rose to 190 mm. The 
respirations were at first extremely shallow, slow, 
and of the abdominal type, gradually increasing in 
rapidity and strength until they became normal. 
At the end of three minutes the blood-pressure stood 
at 190 mm. Natural respirations were re-established, 
and the eye reflexes were present. The blood-press- 
ure then gradually fell to 135 mm., where it remained 
for half an hour. The animal began to struggle and 
required anesthesia. 

After normal respiration and circulation were estab- 
lished, the animal was killed. 

Experiment 236. 
Resuscitation. 

Mongrel dog ; weight, nine kilos. 
The animal was allowed to remain thirty minutes 
after the last beat of the heart, after which resuscita- 
tion was attempted. After ten minutes of the tech- 
nique employed in the previous cases, rhythmic con- 
tractions of the auricles were noted, but resuscitation 
was not accomplished. 

Experiment 237. 
Adrenalin. Normal Animal. 

Male mongrel dog ; fair condition ; weight, ten kilos. 
Ether anesthesia. Thirty mg. of morphin sulphate 
were subcutaneously given. 

Initial blood-pressure, 120 mm.; stroke, 20 mm. 
Thirty c.c. of solution of adrenalin, i to 1000, were 
injected into the femoral vein. The blood-pressure 
sharply rose to 200 mm., the heart became much 
slowed, and the excursions increased in length to 
100 mm. An injection of .5 mg. of atropin into the 



ON THE BLOOD-PRESSURE IN SURGERY. 



femoral vein decreased the stroke to 12 mm., and 
increased the heart-rate. 

Ten c.c. of i to 1000 solution of adrenalin were in- 
jected into the femoral vein. The blood-pressure 
sharply rose to 210 mm. ; stroke, 16 mm. ; pulse but 
slightly increased. An injection of .5 mg. of atropin 
was followed by an irregular and arrhythmic heart. 
The blood-pressure gradually fell to the normal, 
which fall continued until the blood-pressure stood 
at 20 mm. This was followed by a gradual rise in 
the blood-pressure to 130 mm., at which height it 
remained for forty-five minutes. The length of 
stroke was 18 mm. The animal was killed. Time, 
one hour and thirty minutes. 

Experiment 238. 
Resuscitation. 

Dog; good physical condition; weight, ten kilos. 
Ether anesthesia. Asphyxia was produced by clamp- 
ing the trachea. The minute both the respiration and 
heart ceased, saline solution with strychnin was rap- 
idly infused. No efifect was noted. After a lapse of 
thirty-six seconds, artificial respiration, with rhyth- 
mic pressure on the thorax and abdomen, was vigor- 
ously begun. A slight rise in the blood-pressure was 
noted, then the heart slowly resumed action, and the 
blood-pressure rose. 

Experiment 239. 
Resuscitation. 

Dog; old and in poor physical condition; weight, 
thirteen kilos. During the administration of the an- 
esthetic the heart suddenly failed. The respiration 
ceased almost simultaneously. The animal was im- 
mediately inverted head down, then feet down, and 
artificial respiration was supplied, but resuscitation 
failed. 



i 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 240. 
Resuscitation. 

Mongrel dog ; weight, eight kilos. Ether anesthesia. 
The blood-pressure and the respiration were both 
overcome by connecting the trachea with a rubber 
tube four feet long, at the end of which a funnel was 
inserted through which water was poured, rapidly 
filling the trachea. The blood-pressure dropped al- 
most immediately to the abscissa line. After one 
minute and fifteen seconds the dog was inverted, 
thus emptying the trachea. Artificial respirations 
and pressure upon the chest were begun. The blood- 
pressure rapidly rose; respirations were resumed 
after fifteen minutes. The animal was accidentally 
killed in allowing the MgS04 to enter the circu- 
lation. 

Experiment 241. 
Resuscitation. 

Dog; good condition; weight, sixteen pounds. 
Ether anesthesia. The animal was reduced to as- 
phyxia by clamping the trachea. Both the respira- 
tory and cardiac action ceased in five and three- 
fourths minutes. Artificial respiration was then 
begun. After fifty-six seconds the animal was in- 
verted feet down, then head down in rapid alterna- 
tion, each time pressure being applied over the 
thorax and abdomen. On account of the change in 
the dog's position it was not possible to determine 
how much effect was exerted upon the blood-press- 
ure. The animal was then placed in a horizontal 
position, artificial respiration maintained, and hot 
saline solution rapidly given. The blood-pressure 
rose 8 mm. The heart did not beat again. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Experiment 242. 
Resuscitation. 

Dog; fair condition; weight, twenty- four pounds. 
Abdominal aorta was clamped just below the dia- 
phragm. This experiment was intended to give evi- 
dence as to whether or not ether produced a vaso- 
motor paralysis. The anesthetic was pushed until 
the respirations failed. The blood-pressure began 
to decline similar to that in the preceding experiment. 
The animal was inverted head downward. Artificial 
respirations and rhythmic pressure upon the thorax 
were begun. After five minutes respirations were 
resumed and the blood-pressure was largely regained. 
The anesthetic was again crowded after the abdomi- 
nal aorta was undamped. Both respiration and cir- 
culation failed in much the same way as during the 
first administration. The anesthetic was continued 
until both the respiration and the heart ceased. The 
animal was inverted first feet downward, then head 
downward, in rapid succession, and artificial respira- 
tion supplied. Saline solution was hastily given. 
Rhythmic pressure was continued, but the heart did 
not beat again. 

Experiment 243. 
Resuscitation from Ether Collapse. 

Spaniel ; good condition ; weight, seven kilos. Ether 
anesthesia. The anesthetic was not well taken. The 
ether was then pushed until the respirations gradu- 
ally failed, and the blood-pressure showed a marked 
decline. The animal was inverted head downward. 
Rhythmic pressure was made upon the thorax. The 
heart beat stronger, the blood-pressure rose, and natu- 
ral respirations were resumed. After the animal had 
made a good recovery the anesthetic was again 



ON THE BLOOD-PRESSURE IN SURGERY. 



crowded until both respiration and circulation failed. 
Suspension, head downward, with artificial respira- 
tion was of no avail. 

Experiment 244. 
Resuscitation. 

Dog; good condition; weight, ten kilos. Ether an- 
esthesia. The animal was reduced to asphyxia by 
cramping the trachea. In two minutes both the 
blood-pressure and the respirations began to fail. 
The former ceased in four minutes ; the latter in six 
and one-half. After a lapse of twenty seconds saline 
infusion, artificial respiration, rhythmic pressure 
upon the abdomen, and thorax synchronous with the 
artificial respiratory movements were administered. 
The blood-pressure was slightly raised and main- 
tained, the length of the stroke depending on the 
depth and force of the pressure. After ten seconds, 
the heart began to beat slowly and feebly, then 
stronger and faster, until it resumed its normal rate. 
The blood-pressure during this time rose, and after 
twenty minutes natural respiration was resumed. 

Experiment 245. 
Resuscitation from Ether Collapse. 

Dog; good condition; seven kilos. The anesthetic 
was crowded until the respirations ceased. Artificial 
respirations were begun. The blood-pressure in the 
mean time was falling. Saline infusion was rapidly 
infused into the jugular vein. The animal was in- 
clined head up, then head down, in rapid succession. 
The heart did not beat again. 



ON THE BLOOD-PRESSURE IN SURGERY. 



EXPEKIMENT 246. 

Resuscitation. 

Dog; good condition; weight, twenty pounds. 
Ether was given tmtil the dog was under complete 
anesthesia, when chloroform was substituted. The 
trachea was clamped. After four minutes respira- 
tion and circulation began to fail, and at the expira- 
tion of seven and a half minutes had entirely ceased. 
Normal saline solution flowing in a large stream from 
a height of eleven feet was infused into the jugular 
vein. The blood-pressure rose 9 mm. The dog was 
inclined head downward, and pressure was applied 
over the thorax, then head upward, with pressure, 
artificial respiration having been supplied. These 
changes were made as rapidly as possible. The ani- 
mal was then held by the hind legs and rhythmic 
pressure made upon the thorax. A few heart-beats 
were noted. The animal was not resuscitated. 

Experiment 247. 
Asphyxia. Resuscitation. 

Female dog; good physical condition. weight, 
twelve pounds. The trachea was clamped. Two and 
a half minutes later the blood-pressure began to fall, 
and the respirations became slower and more shallow. 
Nine minutes after clamping the trachea respirations 
failed and the heart stopped beating. At the expira- 
tion of forty-eight seconds intravenous saline solu- 
tion was given and continued until 800 c.c. were ad- 
ministered. The saline solution at one time was given 
at 70° C. The heart's action was not resumed. 



17 



ON THE BLOOD-PRESSURE IN SURGERY. 



EXPEEIMENT 248. 

Resuscitation. 

Female dog; weight, nineteen kilos. The animal 
was reduced to asphyxia by clamping the trachea. 
After thirty-five seconds saline solution, artificial res- 
piration, and rhythmic pressure upon the heart were 
simultaneously begun. In forty seconds the heart 
began to beat, at first slowly, then more rapidly, and 
finally normally. The blood-pressure, in the mean- 
time, rose to the normal. 

Experiment 249. 
Resuscitation. 

Dog; good condition; weight, ten kilos. The ani- 
mal was reduced to asphyxia by clamping the trachea. 
After the heart had ceased beating for fifty seconds 
the animal was inclined head up and head down al- 
ternately, after which artificial respiration and saline 
solution, together with rhythmic pressure upon the 
heart, was ineffectual. The blood-pressure could be 
raised alx)ut ten millimetres by this procedure. With 
each pressure upon the thorax over the heart a pulse- 
wave was created. Large doses of strychnin were 
given. No effect followed. 

Experiment 250. 
Resuscitation. 

Dog; bad condition, greatly emaciated; weight, six 
kilos. There was a purulent ophthalmia, and a severe 
rhinitis. The animal was reduced to asphyxia by 
clamping the trachea. Death followed almost imme- 
diately. On attempting to resuscitate by saline in- 
fusion and rhythmic pressure upon the heart, together 
with artificial respiration, a distinct pulse-wave and 
a pressure of nine millimetres was created. The 
heart did not beat again. 



ON THE BLOOD-PRESSURE IN SURGERY. 259 

Experiment 251. 
Resuscitation. 

Mongrel dog; weight, nine kilos. Ether anesthesia; 
blood-pressure cannula in the carotid artery ; cannula 
for infusion of adrenalin in the jugular vein. 
At 4. 1 6, the trachea was clamped. 

At 4. 19, both respiration and heart action had ceased; blood- 
pressure had fallen to abscissa; animal was appar- 
ently dead. 

At 4.29, the clamp was removed from the trachea; artificial 
respiration, rhythmic pressure upon the thorax over 
the heart, and infusion of i to 50,000 adrenalin solu- 
tion into the jugular vein was begun. 

At 4.3 1, there was a slight attempt at breathing; the blood- 
pressure was rising. 

At 4.32, the blood-pressure was rising more rapidly; respira- 
tory action was more pronounced. 

At 4.32.30, distinct heart-beats were recorded on the drum. 

At 4.33.30, blood-pressure had risen to the normal; rhythmic 
pressure upon the heart and adrenalin infusion was 
discontinued; respirations becoming more frequent. 

At 4.35, artificial respiration was discontinued; the blood- 
pressure, which had risen higher than the normal, 
had now fallen to the normal ; the. corneal reflex had 
returned. 

At 5.10, the animal was doing well. 

At 5.35, the forelegs were voluntarily moved; the animal was 
sighing. 

At 6.10, the sighing increased to whining; there was inconti- 
nence of urine; one-fourth grain of morphin was ad- 
ministered. 

At 6.20, pulse, 120; respiration, 38. 

At 6.40, the eye closed when a lighted match was held before it. 
At 7.48, pulse, 114; respiration, 14 ; the animal began to strug- 
gle; reflexes normal. 
At 7.58, pulse, 108; respiration, 14. 



26o ON THE BLOOD-PRESSURE IN SURGERY. 




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ON THE BLOOD-PRESSURE IN SURGERY. 261 



At 8. 1 5, pulse, 104; respiration, 20; the animal tried to rise 
At 8.45, pulse, 100; respiration, 20. 
At 9.30, pulse, 105; respiration, 24. 
At 10.00, the animal barked. 

At 10.10, the dog assumed a struggling gait; hind legs not so 

active as the fore. 
At 1 1. 00, dog sleeping; pulse, 122; respiration, 18. 
At 12.00, pulse, 120; respiration, 20. 
At 12.10, dog restless. 

At 12.30, the periods of restlessness were less frequent. 

At 1. 00, the dog was quiet. 

At 1.25, dog quiet and sleeping. 

At 2.00, the dog had to be restrained. 

At 2.20, pulse, 122; respiration, 22. 

At 2.55, the dog was doing well. 

At 3.40, the dog was quiet. 

At 5.00, pulse, 140; respiration, 32; dog, restless; one-fifth 
grain of morphin was administered. 

At 6. 1 5, pulse, 136; respiration, 16; quiet. 

At 7.15, pulse, 136; respiration, 16; quiet. 

From this time on the animal was kept under suffi- 
cient morphin to remain quiet; the reflexes were 
normal; locomotion was re-established; milk was 
given ; on the second day the animal was killed. 

SUMMARY OF EXPERIMENTAL DATA. 
Alcohol. 

The immediate effect of intravenous administration 
only was observed. The first effect usually noted 
was a decline in the blood-pressure. In the majority 
of such instances a compensatory rise followed; in 
a number of instances no change in the blood-pressure 
was noted ; in but few was there a rise. The average 
length of the stroke of the manometer (height of 



262 



ON THE BLOOD-PRESSURE IN SURGERY. 



pulse-wave) was increased. There was no evidence 
that the heart beat more forcibly. In animals reduced 
to varying degrees of surgical shock, the usual effect 
of an average dose of alcohol was the production 
of a further depression ; in smaller doses but little 
effect was noted, while in larger doses a more marked 
decline often occurred. In a few instances the ad- 
ministration of a considerable dose in deep shock 
was followed by almost immediate death. . In a 
number of experiments the decline in the blood- 
pressure was as prompt and as marked as in the 
administration of the amyl nitrite and nitroglycerin. 
In no instance, in the normal animal, did death im- 
mediately follow the largest dose of alcohol ; the 
more profound the shock the more marked was the 
depressing effect of alcohol. In a number of experi- 
ments alcohol was given prior to procedures intended 
to produce shock. It is not certain that it rendered 
the animal more susceptible. It is quite certain that 
the susceptibility was not diminished. 

Nitroglycerin and Amyl Nitrite. 

The immediate effect of nitroglycerin and amyl ni- 
trite upon the pulse was an increase in its volume 
and a decrease in frequency. The immediate effect 
upon the respiration varied. At times there was 
a slight increase, more frequently a slowing of 
respiration. The immediate effect upon the blood- 
pressure in almost every instance was a fall. The de- 
cline was usually rapid. There were but few excep- 
tions, and in these there was usually no effect. A 
rise was rarely observed. In the latter it was but 
temporary and was usually followed by a fall. The 
descent in the blood-pressure was gradual and rather 
rapid, the ascent, more gradual. Compensation usu- 
ally took place in a few minutes, the rising curve 
being more gradual than the falling. The portion of 



ON THE BLOOD-PRESSURE IN SURGERY. 263 



the curve representing the deepest part of the decUne 
was rounded. Compensation in the majority of ex- 
periments was complete. In those experiments in 
which the later blood-pressure was not equal to that 
before the administration of nitroglycerin it was usu- 
ally lower. On repeating the doses the effects each 
time were almost as marked as the preceding, even 
when the repetitions were at short intervals. On 
administering repeated doses, each in turn being 
twice as large, the effects were proportionately in- 
creased. Most of the animals tolerated very large 
repeated doses ; excessive doses produced convulsions 
and respiratory failure. The blood became darker 
before the animal died. 

During the convulsion the blood-pressure rose and 
fell with the muscular spasms. In the experiments 
in which the animal was in deep shock and the 
blood-pressure was gradually falling, there was no 
evidence to show any decrease in the rapidity of 
the decline. On the contrary, as nearly as could 
be estimated, nitroglycerin distinctly increased the 
rapidity of the decline. The effect of nitrite of amy! 
was in every respect similar to that of nitroglycerin. 
In many instances the heart beat irregularly after 
the injection. On the whole, nitroglycerin and amyl 
nitrite increased shock. 

Digitalis. 

In these experiments the fluid extract, the tincture, and 
digitalin were used. In the normal animal therapeutic 
doses of digitalis, intravenously administered, caused 
a rise in the blood-pressure. The rise began after a 
latent period of half a minute to several minutes and 
gradually increased until the maximum was reached. 
The maximum was well sustained for a considerable 
time. The pressure finally assumed about its previous 
level. During the ascent, the continuation, and the 



ON THE BLOOD-PRESSURE IN SURGERY. 



descent the curve was usually even ; the length of the 
pulse-wave was usually increased ; the heart's action 
was considerably increased in force and appreciably di- 
minished in frequency. When given in larger doses, or 
when smaller doses were repeated beyond therapeutic 
limits, the blood-pressure rose higher and more ab- 
ruptly. The heart at first beat with greatly increased 
force and diminished frequency. The intermissions 
which were sometimes noted were usually the first 
symptoms of a cardiac break-down. The latter was 
manifested by slow, powerful beats, followed by a 
varying number of rapid, weaker contractions, making 
an irregular blood-pressure curve. If the over-stimu- 
lation fell short of a fatal break-down, the intervals of 
alteration between the slow, powerful contraction 
and the rapid, weaker ones increased, later only inter- 
missions appearing; finally the normal rhythm was 
re-established. In the experiments in which the over- 
stimulation reached the fatal break-down, the altera- 
tions became more marked and the heart suddenly 
stopped. The force of the contractions in some in- 
stances was so much increased as to raise the tho- 
racic wall and even shake the entire animal. In the 
experiments in which both vagi and accelerantes had 
been previously severed, the effects were not so 
marked. In careful measurements of twenty-eight 
experiments on single doses, the mean rise in the 
blood-pressure was 8 mm. In animals reduced to 
varying degrees of surgical shock, digitalis usually 
caused a rise in blood-pressure. When the animal 
was reduced to such a degree of shock that burning 
the paw or stimulating the sciatic nerve caused no 
rise in the blood-pressure, digitalis caused a slight, if 
any, rise. The highest rise was lo mm. 
When over-stimulation was obtained by administer- 
ing too large a single dose or by repeating smaller 
doses the heart became extremely irregular or the 



ON THE BLOOD-PRESSURE IN SURGERY. 



animal died suddenly from cardiac failure. In some 
instances convulsions occurred. 

The respiration when at all affected was either im- 
paired or arrested. Death in the digitalis experi- 
ments, even in those in which the dosage was only 
therapeutic, was usually more sudden than in the con- 
trols. Although the data does not permit positive 
statements, it seemed, on the average, that cases of 
shock treated by digitalis did not live as long as 
the controls. It may certainly be stated that they 
did not live longer than the controls. In the experi- 
ments in which the medulla was cocainized and those 
in which the cord was severed just below the medulla, 
digitalis cavised a distinct rise in the blood-pressure. 
When the heart had entirely ceased, digitalis intro- 
duced by intravenous infusion or by direct injection 
into the chambers of the walls of the heart did not 
produce any appreciable effect. The animals showed 
considerable idiosyncrasy in their reaction to digi- 
talis. 

Strychnin. 

In the majority of instances, in the normal animal, 
when sufficient amount of strychnin was given to 
cause an increased excitability of the spinal cord, as 
indicated by heightened reflexes and an increased 
muscular tone, a rise in blood-pressure was noted. 
In smaller doses, occasionally, a slight immediate fall, 
a slight immediate rise, or later irregularities were 
noted, but on making forty-eight careful measure- 
ments of the effects, it was found that no noteworthy 
changes occurred. 

The stage of increased excitability above mentioned 
represented the border-land between the dosage with- 
out effect upon the blood-pressure and that of maxi- 
mum effect. When more was given after this stage 
had been reached, convulsions appeared, and the 
blood-pressure rose abruptly, and high, sometimes 



266 



ON THE BLOOD-PRESSURE IN SURGERY. 



even more than doubling the normal. The curve dur- 
ing the convulsions was exceedingly irregular, and 
continued for some time above the normal, exhibiting 
a secondary rise if later convulsions occurred. The 
simultaneous appearance of the rise in the blood- 
pressure and the increased tendon reflexes occurred 
in those cases in which very small doses were given 
at repeated intervals, and in the cases in which this 
effect was obtained in a single dose. 
In a series of experiments in which convulsions were 
prevented by physiologic doses of curare, and in 
which convulsive doses of strychnin were given, the 
blood-pressure rose as high as in the experiments in 
which convulsions occurred. 

In another series, in which both vagi and accelerantes 
were severed, curare given, and varying doses of 
strychnin administered, the general effect upon the 
blood-pressure did not differ materially from the ef- 
fects of corresponding doses upon the normal animal. 
In the curarized animal and in the animal having both 
vagi and both accelerantes severed the rise following 
the physiologic dose of strychnin continued from a 
half to one and one-half hours. Repetition of the 
dose caused a second rise, in some instances as high 
as the first, though usually not so high, and it did not 
continue more than half as long. On administering 
the third dose (physiologic,) the blood-pressure gener- 
ally rose, though not so high, and continued for a 
shorter period, usually but a few minutes. On repeat- 
ing the dose, a period was soon reached in which no 
further effect was noted. After each dose, when the 
effect had worn off, the blood-pressure fell to a lower 
level than it was before the injection was given, until 
finally it reached the level, usually between 20 and 
30 mm., which was not altered by an additional 
dosage. If during the time of maximum rise, follow- 
ing a physiologic dose, an equal or greater dose was 



ON THE BLOOD-PRESSURE IN SURGERY. 



given, a temporary rise of from 5 to lo mm., con- 
tinuing but a few seconds, was noted. Burning the 
paw and electrically stimulating the sciatic nerve, so 
long as the repeated doses of strychnin caused a rise 
in the blood-pressure, were followed by a rise of 
about the same height, though of less duration, as 
that in the normal animal. 

When strychnin no longer produced a rise, no effect 
was noted on burning the paw or on electrically stim- 
ulating the sciatic nerve. The length of the pulse- 
wave was markedly increased during the rise of the 
blood-pressure : in some instances, it was increased 
fivefold. As the blood-pressure declined, the length 
of the pulse-wave diminished and finally disap- 
peared. 

During the maximum stimulation the blood-pressure 
curve was usually even, but as the strychnin effect 
diminished, the curve became irregular ; between the 
end of the maximum curve and the beginning of the 
final break-down, the curve was quite irregular. 
After the inauguration of the final break-down, the 
curve became more irregular. When this stage was 
reached, it was usually not possible to distinguish 
between the terminal curve in the strychnin experi- 
ments and the terminal curve in the shock experi- 
ments. Small doses of strychnin seemed to improve 
respiration. Larger doses were frequently followed 
by respiratory failure. After the blood-pressure had 
reached the stage of terminal helplessness, the ad- 
ministration of saline solution caused a rise, which 
continued for some time during the flow. On ces- 
sation of the saline infusion, the blood-pressure fell 
to the previous level, and if the infusion continued 
beyond a certain limited period of time, the blood- 
pressure fell to or near its former level during the 
infusion. The administration of adrenalin, after 
the final strychnin break-down had occurred, was fol- 



268 



ON THE BLOOD-PRESSURE IN SURGERY. 



lowed by a rise in proportion to the amount given, — 
in one instance as high as 260 mm. Bandaging and 
other means of external pressure produced a rise of 
blood-pressure. Digitalis administered in the termi- 
nal break-down in the strychnin experiments pro- 
duced slight, if any, rise in the blood-pressure. 
In the animals in which both vagi and both acceler- 
antes had been severed, no change in the pulse-rate 
was noted. In animals in which varying degrees 
of shock had been produced, strychnin caused a rise 
in the blood-pressure proportional to the degree of 
shock. In the cases in which but slight shock existed, 
the rise and its continuation were correspondingly 
less. On repeating the injections, usually no rise 
occurred. In the cases in which shock was developed 
to nearly the fatal degree, only a slight rise occurred, 
lasting but a few minutes, after which no amount of 
strychnirf produced a rise. In any degree of shock, 
after the administration of a therapeutic dose of 
strychnin, the animals passed into deeper shock. 
In the experiments in which the animals were bled 
until the blood-pressure had fallen to the level of the 
final break-down from excessive doses of strychnin, 
the administration of the therapeutic doses of strych- 
nin caused a marked rise in the blood-pressure. In 
the experiments in which the medulla was cocainized 
and therapeutic doses of strychnin were given, 
causing convulsions, but a temporary slight rise in 
the blood-pressure occurred. This rise was noted 
only during the convulsions. 

In another series in which both the medulla and the 
spinal cord were cocainized and an excessive dose of 
strychnin given, convulsions did not occur and no 
rise in blood-pressure was noted. 
Adrenalin in the foregoing cavised a rise in the blood- 
pressure proportional to the dose — a rise as high as 
260 mm. Hg. 



ON THE BLOOD-PRESSURE IN SURGERY. 269 



Saline Infusion. 

Summary of Experimental Data. — In every observation 
upon animals in shock, saline infusion caused a rise 
in the blood-pressure. The rise was usually grad- 
ual. The difference between the systolic and dias- 
tolic pressure was increased. The rise was sustained, 
proportional to the degree of shock. In the cases of 
moderate shock the gain in pressure was fairly well 
sustained. In the cases in which shock was so deep that 
stimulating the sciatic nerve, burning the paw, and ad- 
ministering physiologic doses of strychnin caused no 
rise in the pressure, the rise on infusing saline solution 
was not so marked and not so well sustained. The 
deeper the shock, the longer the pulse-wave became 
during saline infusion. In the cases of deepest shock, 
the rise in the blood-pressure was not sustained be- 
yond a certain time, even during the infusion. In this 
class of cases the systolic pressure rose much higher 
than the diastolic. In some instances in the most 
extreme cases the systolic rose, but the diastolic re- 
mained unchanged. In a greater number of observa- 
tions when the marked difference between the rise of 
the systolic and the diastolic pressures occurred there 
were neither Traube-Hering nor other undulations 
of vasomotor origin observed. In cases in which the 
blood-pressure had fallen to or near the abscissa line 
from asphyxia, on the administration of saline in- 
fusion there was also a marked divergence in the 
rise in the systolic and the diastolic pressures, but 
Traube and other vasomotor undulations usually ap- 
peared upon the blood-pressure tracing. Blood- 
counts and hemoglobin estimations showed that the 
blood was not much diluted by the saline. The 
solution escaped from the vessels at a rate fairly 
proportional to the rate of infusion, mainly through 
the channels of normal absorption of water. The 



ON THE BLOOD-PRESSURE IN SURGERY. 



fluid accumulated in the walls and the lumen of the 
stomach, the intestines, and the abdominal cavity, — 
in the respiratory tract, the thoracic cavity, and the 
subcutaneous tissue. 

When the infusion approximately equalled 320 c.c. 
per kilo, the amount of fluid accumulated in the 
splanchnic area caused embarrassment, even failure, 
of respiration, by mechanically fixing the diaphragm 
and the movable ribs. 

Adrenalin. 

Historical Account. — The marked action of suprarenal extract 
upon the vascular system has, since first announced 
By Oliver and Schaffer, been corroborated from 
many sources. There has arisen from these different 
investigations a conclusion which accredits the ex- 
tract of the suprarenal gland as being the most power- 
ful vasoconstrictor, as well as the most active cardiac 
stimulant known. Abel, in 1897, announced his dis- 
covery of the active principle of suprarenal extract, 
and termed it Epinephrin. O. V. Furth, soon after, 
denied this, stating that epinephrin consisted in part 
of certain impurities, and it could not therefore be 
viewed as the principal ingredient of suprarenal ex- 
tract. Fvirth then claimed that he had successfully 
isolated the real active principle, — viz., suprarenin. 
Takamine next, in 1901, proclaimed the blood- raising 
principle to be the ingredient which he had succeeded 
in isolating, and which he termed adrenalin. It is 
this substance which has since almost universally been 
recognized as the active principle of the extract of 
the suprarenal gland, and which since its discovery 
has been most extensively applied on both an experi- 
mental and clinical basis. The effects of the supra- 
renal extract are essentially those of adrenalin, so 
that, in the further consideration of this subject, their 
action can be practically assumed to be homologous. 



ON THE BLOOD-PRESSURE IN SURGERY. 271 

As already stated, the most prominent, if not char- 
acteristic efifect of adrenalin, is evidenced in a certain 
phenomena attendant on the vascular system. Most 
distinct of these is the rise in blood-pressure which 
was first demonstrated by Oliver and Schaffer. These 
investigators state that after the intravenous injec- 
tion of suprarenal extract there invariably occurred 
a rise in the blood-pressure, never a fall, even tem- 
porarily at the commencement of the injection, al- 
though a period of latency between the injection and 
the commencement of the rise of the blood-pressure 
in the artery, which in the dog averaged twency 
seconds, constantly occurred. This rise was ob- 
served to have been usually very rapid, although in 
many cases a rapid rise for a few millimetres was 
followed by a more gradual rise, or even in a few 
instances by a slight decline. An even more rapid 
rise than the first then instantly followed. The maxi- 
mum of the height was not maintained, as a gradual 
decline soon occurred, the normal level being again 
regained after a somewhat variable time, — this being 
partly dependent on the animal employed, and partly 
on the amount and the potency of the extract. The 
longest time that the action of the extract on the 
blood-pressure was prolonged was found to be four 
minutes in the case of a dog (weight, twenty kilos; 
dose, .19 gramme) and six minutes in the case 
of a rabbit (dose, .96 gramme). With the con- 
tinuous flow of the extract into the vein, however, 
the pressure was kept up as long as the flow was con- 
tinued, and for the usual time after it had been dis- 
continued. 

Almost simultaneously with the experiments of 
Oliver and Schaffer appeared those of Ssymonowicz 
and Cybulioz, who, in an attempt to determine the 
function of the suprarenal gland, report a series of 
thirteen experiments on dogs and one on a cat, in 



ON THE BLOOD-PRESSURE IN SURGERY. 

which this gland was either first excised or remained 
in situ, and a watery or alcohohc extract of this gland 
was then injected intravenously. The action thus 
obtained was evidenced in a slowing of the pulse, a 
rise in the blood-pressure, and a decrease in the 
respiratory movements. The period of latency be- 
tween the time of the injection and the beginning 
of the rise in the blood-pressure varied from five to 
twenty-one seconds. The height to which the blood- 
pressure rose in the arteries was very great, in a few 
cases passing much beyond 300 mm. Hg. In one ex- 
periment this occurred twice. The time in which it 
reached its maximum varied from thirty to sixty sec- 
onds after the intravenous injection. Large varia- 
tions from fifteen to one hundred and fifty seconds 
were, however, not infrequent. The duration of these 
appearances, as well as the fall in the blood-pressure 
to its former level, were dependent, so far as could be 
determined, upon the amount administered and its 
concentration. Gottlieb, in his experiments on rab- 
bits, found that the intravenous injection of supra- 
renal extract caused the blood-pressure to suddenly 
rise after a period of latency of sixty seconds. It 
reached its maximum from five to eight seconds after, 
remaining there two or three minutes, then gradually 
falling in the next ten or fifteen seconds to its former 
level. In instances in which the blood-pressure had 
been artificially reduced a much longer duration of 
this effect (about thirty minutes) was noted. After 
the blood-pressure had fallen to its former level the 
experiment could be repeated several times with the 
same result. In this manner the blood-pressure could 
be kept above the normal by the repeated injections 
of the extract for a longer time. 
Langlois, injecting suprarenal extract from a frog 
intravenously into a dog, obtained a rise of blood- 
pressure from II to 14 mm. and an increase in the 



ON THE BLOOD-PRESSURE IN SURGERY. 



rhythm of the pulse from 27 to 19 in ten seconds. 
The duration of this action was noted to last for 
forty-four seconds. On again repeating this pro- 
cedure, after saline had caused no effect, a rise from 

12 to 15 cm. in the pressure and a decrease in the 
pulse of from 26 to 18 were obtained. 

The duration of this action was sixty-five seconds. 
In later reports of experiments similar to this, a pro- 
portional rise in the blood-pressure was obtained. 
Vardier, in his experiments on rabbits, reports that 
after the intravenous injection of suprarenal extract, 
in accordance with the reports of most observers, the 
arterial pressure rose considerably, — i.e., from 10 or 

13 to 22 or 25 cm. Hg. This rise, however, only 
persisted for two or three minutes, falling again to 
its former level. Similar and identical observations 
are furthermore reported by Radziejewski, Frenkel, 
Telich, Reichert, and others. 

Miles and Muhlberg, after causing a vasomoter col- 
lapse in rabbits by the admitiistration of ether, noted 
that an intravenous injection of adrenalin was fol- 
lowed by an immediate and powerful rise of the 
blood-pressure, which persisted about five minutes. 
This rise is stated to have been higher than the origi- 
nal pressure before the ether poisoning. About one 
minute later the pressure gradually sank to the level 
recorded before the injection was given, but not below 
this level. The action of adrenalin on the cardiac 
organ appears next to that on the arterial system as 
being the most remarkable. Observations, however, 
are at variance. Oliver and Schafifer reported an 
argumentation in the cardiac beats. Ssymonowicz, 
on the other hand, states that the effects noted on the 
heart were a slowing of its action Avith an increase in 
its contraction, which usually appeared soon after the 
beginning of a rise in the blood-pressure, and which 
reached its maximum shortly before that in the rise 
18 



ox THE BLOOD-PRESSURE IX SURGERY. 



of the blood-pressure. The heart's action then slowly 
but gradually increased again, and with a return of 
the blood-pressure to the normal the pulse also re- 
sumed its former or a greater freqviency. The degree 
of decrease in the cardiac action was not always in 
fixed ratio to the height of the blood-pressure, or the 
quantity of the extract injected, although in general 
the greatest decrease was consistent with the greatest 
height in the blood-pressure after repeated injections; 
as already noted, the rise in the blood-pressure was 
always less, but the slowing of the cardiac action be- 
came greater. 

Gottlieb next in his experiments reports that simul- 
taneously with a rise in the blood-pressure a slowing 
of the pulse was noted, which at the maximum of 
the blood-pressure changed to an acceleration. 
Cyon obtained similar results in rabbits and dogs. 
It was observed by him that simultaneously with the 
rise in the blood-pressure there occurred a marked 
slowing of the heart-beats, whose action was stronger. 
This slowing of the heart immediately ceased, and the 
blood-pressure reached its maximum, it then being re- 
placed by a distinct acceleration ; the amplitude of the 
pulse wave at this time was decreased. The accelera- 
tion of the pulse not only persisted during the period 
of high blood-pressure, but also for some time after- 
Avards. and when not interrupted by experimental 
insults usually persisted to the end of the experiment. 
In dogs a transient beginning or slowing of the pulse 
was very seldom observed. The blood-pressure usu- 
ally rose very rapidly, and from the beginning of this 
rise the pulse was already accelerated. In these ani- 
mals also, the acceleration of the heart-beat was of 
longer duration than the rise of blood-pressure, and 
often persisted for ten or twenty minutes with a nor- 
mal blood-pressure. The rise in the blood-pressure 
and the acceleration of cardiac contractions were in 



ON THE BLOOD-PRESSURE IN SURGERY. 275 

all cases much more noticeable in dogs than in rab- 
bits. Barger, in his observations on rabbits, found 
that upon the heart suprarenal extract first caused a 
distinct slowing in rhythm and an increased force of 
contraction. The slowing was very marked, there 
being a decrease of from five to three beats per sec- 
ond. Subsequently the cardiac action became ar- 
rhythmic, the pulse being still slowed, after which 
the return to the normal occurred. 
Radziejewski also states that with the rise in blood- 
pressure a slowing of the pulse occurred, which, at 
the maximum of the blood-pressure, was followed by 
acceleration. 

The exact el¥ect of suprarenal extracts and adrenalin 
upon the vascular system — the heart and vessels — is 
still a subject of controversy; while some authorities 
assume the effect to be central, others hold that this 
action is wholly peripheral. Oliver and Schaffer 
stated that suprarenal extract affected peripheral 
parts of the vasomotor system, basing their conclu- 
sions on the fact that the rise in the blood-pressure 
occurs equally after the dissection of the cord, as well 
as after the section of the nerve leading to the limbs. 
A direct effect on the muscular tissues of the heart 
and vessels is said to occur. Cybulski and Ssymono- 
wicz, on the other hand, assumed that the vascular 
system is affected through the medium of the central 
nervous system, the vasomotor centres of the me- 
dulla and of the spinal cord being said to be stimu- 
lated. Simultaneously with the stimulation of these 
centres a stimulation of the vagus centre is also stated 
to occur, the slowing of the cardiac contractions re- 
sulting therefrom. Biedl inclines to the opinion that 
action of suprarenal extract is on the peripheral parts. 
In the extirpation of the medulla in mammalia, as 
well as after the extirpation of the whole spinal cord, 
he succeeded in raising the blood-pressure by means 



ON THE BLOOD-PRESSURE IN SURGERY. 



of this drug from 90 to 160 mm. Hg., and to keep 
the animals ahve for over half an hour. Death after 
destruction of large pieces of the spinal cord is stated 
to occur from the loss of vascular tone, the blood 
thereby accumulating in the relaxed veins, so that the 
heart is rendered anemic. The immediate intra- 
venous injection of suprarenal extract, however, 
served to raise the blood-pressure, which had fallen 
to zero, to 160 mm. Hg., and by repeated injections 
this could be held for some time from 90 to 140 mm. 
Hg. This rise in the blood-pressure is concluded to 
be produced not by the direct stimulation of the vaso- 
motor centre, but by the tonic influence on the mus- 
cles of the vessels and the heart. Velich also found 
that after the total destruction of the spinal cord a 
transient rise in the blood-pressure could still be pro- 
duced. In paralysis of the vasomotor centre, as by 
large doses of chloral hydrate and curare, the same 
efifect of suprarenal extract was also noted. 
Gottlieb gives a somewhat more complicated expla- 
nation. He assumes that in the first instance the 
action of suprarenal extract is exerted on the periph- 
eral portion of the heart and vessels; the rise in the 
blood-pressure is, however, stated to be in part de- 
pendent on the strengthened cardiac activity. He 
observed that in his experiments, after the paralysis 
of the vasomotor centres with chloral hydrate, a dis- 
tinct rise in the blood-pressure of from 20 to 30 mm. 
Hg. to 70 to 80 mm. Hg. constantly occurred. The 
rise in the blood-pressure is therefore concluded to 
be due to the peripheral effect on the heart and blood- 
vessels. To differentiate whether the heart or the 
vessels play the most important factor in the rise in 
the pressure, chloral hydrate was administered to 
the point at which the vessels were dilated ad maxi- 
mum, and the minimal blood-pressure of 10 to 20 mm. 
Hg. was totally supported by the force of the heart. 



ON THE BLOOD-PRESSURE IN SURGERY. 277 

In this condition, a constriction of the vessels is as- 
sumed not to be probable, the large pulsatory oscilla- 
tions, which the cardiac activity still produces in the 
totally relaxed vessels, grow less with the continued 
administration of chloral hydrate, and the pulse is 
slowed. Intravenous injection of suprarenal extract 
raises the blood-pressure in this condition very 
markedly, as from 15 to 70 mm. Hg. A Roys on- 
cometer applied upon the kidney during this rise of 
blood-pressure gives no indication of constriction of 
the vessels, while in animals but slightly chloralized 
this still occurs. The increase in the cardiac force, 
however, is apparent, in that the small pulse greatly 
increases in volume. This seems to indicate that the 
increase in the cardiac action is the most important 
factor in the rise of the blood-pressure. The exact 
portion of the cardiac organ which is directly affected 
is, from further experiments, stated to be the con- 
tained intracardiac ganglia, and not the muscular tis- 
sue itself. 

Cyon, in adopting the view that the effect of supra- 
renal extract is exerted on the central nervous organs, 
denies that the experiment of extirpation or destruc- 
tion of the spinal cord can bring the proof to the 
contrary. He bases this denial on the fact that the 
blood-pressure, as has been shown, does not occur 
momentarily, but in a measurable period of time. 
The result of this experiment is furthermore said to 
be misleading in that the operative interference often 
causes a passing irritation of the vasomotors. To 
definitely decide this question or controversy, section 
of the splanchnics should be performed. In experi- 
ments in which the blood-pressure has been raised 
by means of suprarenal extract from 180 to 210 mm., 
the severing of the splanchnics, after qviickly opening 
the abdominal cavity, produced a fall of from 196 
to 15 mm., within eight seconds. The animal did not 



ON THE BLOOD-PRESSURE IN SURGERY. 



recover. The result of this experiment is held to 
conclusively prove that the stimulation of the vaso- 
motor centre occupies an important part in the rise 
of the blood-pressure. 

Velich makes the assertion that the effect of supra- 
renal extract on the vascular system is both central 
and peripheral; that the constrictor centres of the 
spinal cord must be effected is concluded from the fact 
that larger doses of the extract are required when the 
cord is excised than when it remains intact ; that the 
loss of blood is not the cause of essential increase 
of dosage was shown in certain experiments, in which 
after a profuse hemorrhage but a small dose was 
sufficient to produce the rise in pressure. The con- 
stricting centres of the cord must, therefore, to some 
extent be involved in the action of the suprarenal 
extract upon the vascular system. Peripherally either 
the vessels themselves or the vasoconstrictor nerve 
apparatus is affected. 

That on the heart, at least, the action of suprarenal 
extract is not exerted by the intravention of the cen- 
tral nervous system is indicated in the experiments 
in which the resuscitating powers of this substance 
have been demonstrated. Hedson in perfusing this 
extract through the coronary arteries of the isolated 
cat's heart found that a strong tonic influence was 
exerted upon its contractions, and that this effect 
lasted a few hours. 

Gottlieb observed that after chloral hydrate had been 
administered to the extent that stoppage of the heart 
was produced, so that its contractions were no longer 
apparent to the eye, injection of suprarenal extract 
resuscitated this organ. This resuscitation could 
be accomplished after the heart had ceased beat- 
ing five minutes, providing that this remedy was as- 
sisted by the compression of the thorax on the sys- 
tole of the heart. After injection of the extract, but 



ON THE BLOOD-PRESSURE IN SURGERY. 279 

a few compressions of the thorax, even one to five 
minutes after the last spontaneous pulse-beat, were 
sufficient to again re-establish the cardiac contrac- 
tions, which so rapidly increased in frequency that 
the blood-pressure in a remarkably short time, from 
one-half to one minvite after the heart-beats had been 
re-established, registered fifty to sixty mm. Hg. In 
seventeen such attempts the resuscitation of the heart 
failed but in two instances, and in these it had been 
too powerfully depressed by too long chloralization, 
— from two to three hours. The distinct effect of 
the extract on the heart has also been demonstrated 
by Cleghorn in perfusing a solution of suprarenal 
extract through the coronary arteries of the isolated 
dog heart; the apex answered almost immediately 
to the presence of the extract, the pulse wave being 
often more than double the height of the normal, 
while the rhythm was slightly quickened. No altera- 
tion in the tonus was noticed unless the perfusion 
was carried on for some time, when a gradual rise 
took place, until the apex ran into fibrillar contrac- 
tions. Provided the first dose was of short duration, 
about two minutes, and not too strong, the effect 
gradually wore off, and the heart did not respond to 
a second dose in so marked a manner, nor so readily 
as in the first. A strong dose of the extract, about 
ten per cent, saline extract, would, as a rule, cause 
the apex to fibrillate after giving four or five enor- 
mous contractions. 

Adrenalin. 

Summary of Experimental Data. — In the normal ani- 
mal in every degree of shock and collapse, when 
the medulla was cocainized, when in addition the 
spinal cord was cocainized, when the cord was sev- 
ered, and when in addition the medulla was de- 
stroyed, when the splanchnic nerves were severed, 



28o 



ON THE BLOOD-PRESSURE IN SURGERY. 



when the heart, the respiration, and the vasomotor 
action were arrested by 2300 volts of an alternating 
current, when the animal was decapitated, and when 
it was apparently dead as long as fifteen minutes, 
adrenalin administered intravenously caused a rise 
in the blood-pressure. In all of the foregoing con- 
ditions the blood-pressure could be raised even higher 
than the normal. The latent period, approximately 
twenty seconds, and the duration of the effect, nearly 
two minutes, was about the same in all. The heart 
was at first slowed, and later was increased in fre- 
quency. The force of the heart-beats was increased. 
The blood-vessels were contracted. In larger doses 
the heart was extremely slowed, exhibiting marked 
inhibitory phenomena. Atropin in most instances re- 
lieved the inhibition. The effect of the atropin soon 
wore off, after which the inhibition reappeared, but 
later it disappeared. 

On observing exposed blood-vessels during the active 
phase of a physiologic dose of adrenalin, their con- 
traction could be plainly seen, and there was dimin- 
ished hemorrhage on cutting the muscles and skin. 
On palpating the heart and the blood-vessels a hard 
resistance was noted. On injecting adrenalin into 
the heart muscle, marked pallor and local contractions 
immediately followed. The rhythm of the heart was 
lost. On injecting adrenalin directly into the cham- 
bers of the heart, a break-down from over-stimulation 
followed. Its effect upon the walls of the blood- 
vessels continued for some time after death, at least 
after what is conventionally called death. 
On a beheaded animal the effect was obtained con- 
tinuously for ten and one-half hours. Clinically, it 
was given continuously for eight hours in a patient 
dying of shock. By the combined effect of artificial 
respiration, rhythmic pressure upon the thorax over 
the heart, and intravenous infusion of adrenalin in 



ON THE BLOOD-PRESSURE IN SURGERY. 281 



normal salt solution, a human heart which had 
stopped beating for nine minutes was made to beat 
thirty-two minutes. 

Morphin. 

Summary of Experimental Data. — In a large series of 
experiments in this and other researches mixed anes- 
thesia of morphin and ether was used. Morphin 
alone, or morphin combined with ether, prevents, to 
a considerable degree, the animal's susceptibility to 
shock. There can be but little doubt that morphin 
and ether, combined, form an anesthetic under which 
more extensive operations and procedures over a 
longer period of time are possible than by means of 
ether or chloroform anesthesia alone. Chloroform 
anesthesia alone is decidedly more depressing. Ether 
alone, though less depressing than chloroform, does 
not permit of so much dissecting and experimenting 
as ether and morphin compined. 

On the Mixed Effect of Certain Drugs. 

Summary of Experimental Data. — Digitalis and strych- 
nin supplement each other very well. Digitalis sup- 
plements strychnin, which has no specific action upon 
the heart, but heightens the excitability of the me- 
dulla and of the spinal cord. It not only heightens 
the excitability, but also stimulates the centres. In 
both these drugs the steady rise following their ad- 
ministration is usually well sustained, indicating that 
in most of their phases of action they supplement each 
other. In nitroglycerin, in every experiment in which 
an effect was noted, there was a fall in the blood- 
pressure, whether given after or simultaneously with 
strychnin and digitalis. In some instances compen- 
sation was only partial, in others it was complete. 
Aside from the cases in which a slight rise occurred 
at the moment of injection, the action of alcohol in- 



282 ON THE BLOOD-PRESSURE IN SURGERY. 



dicated it to be a progressive depressant. One might 
be able to so adjust the dosage of strychnin, digitaHs, 
alcohol, and nitroglycerin that they might neutralize 
each other in their immediate effect upon the blood- 
pressure. The experimental data show that the treat- 
ment of shock by the most commonly employed stimu- 
lation — namely, strychnin, brandy, digitalis, and 
nitroglycerin — produced systemic confusion in the 
animal. 

Preliminary Resection or Cocainization of the Stellate Gan- 
glia as a Means of preventing Shock. 

Summary of Experimental Data. — The experiments upon 
the dead animals, as well as the living, showed that 
the position of the ganglion in the upper part of the 
thorax, at the base of the first intercostal space, is 
so inaccessible and is surrounded by such important 
structures, whether approached from the neck or 
through the thorax, that exposure and direct applica- 
tion of cocain necessitated so much dissection that 
it amounted to a capital operation in itself, causing 
very marked shock before the means of prevention 
could be applied. In the neck dissection, it was 
not only deep, but dangerous. Approaching the 
ganglia through the thorax exposed the animal to 
the peculiar dangers of intrathoracic procedures. 
On the other hand the injection of the ganglia by 
means of a needle was attended by the danger of 
wounding important vessels and by the difficulty of 
accurately reaching the ganglia; that is to say, the 
procedure is as uncertain as it is difficult, and when 
successful did not prevent shock. 

On the Effect of Pressure upon the Circulation. Summaries. 

(b) Atmospheric Pressure. — Observations upon the efifect of 
variations in the atmospheric pressure upon the 
blood-pressure were made by placing animals in an 



ON THE BLOOD-PRESSURE IN SURGERY. 283 



iron cylinder. These observations may be grouped 
under the following heads, comprising a series of 
normal animals and of animals in shock and in col- 
lapse. 

First. — On the effect of an increased general atmos- 
pheric pressure. 

Second. — On the effect of a diminished general at- 
mospheric pressure. 

Third. — On the effect of inhaling air under increased 
pressure while the remainder of the body was under 
normal pressure. 

Fourth. — On the effect of breathing air at the normal 
pressure while the remainder of the body was sub- 
jected to increased pressure. 

First. — On the effect of an increased general atmos- 
pheric pressure. 

On increasing the atmospheric pressure in the tube, 
the blood-pressure rose proportionately to the in- 
crease; the proportion of increase was about equal 
in all the exposed vessels of the body ; e.g., the carotid 
artery, jugular vein, femoral artery and vein, in- 
cluding both the central and the peripheral pressures. 
In a series of experiments, records of the changes in 
the pressure in the abdomen, in the thorax, in the 
skull, in the deep tissues of the extremities, in the 
various arteries, in the left ventricle, and in the tube 
itself were made. It was found that the changes in 
the arterial pressure most nearly parallel the changes 
in the tube. Next in order was the intra-abdominal, 
then the intrathoracic, then the intracranial; that 
is to say, the arterial pressure rose the most, the 
intracranial the least. The intracranial circulation 
was therefore increased. The above was noted in the 
normal animal and in every degree of shock. It 
should be particvdarly noted that the various portions 
of the vascular systems were quite evenly affected, 



ON THE BLOOD-PRESSURE IN SURGERY. 



excepting as certain vessels were protected ; e.g., the 
brain and the thorax. The animals reduced to pro- 
found shock and placed in an atmosphere of increased 
pressure lived longer than the controls. On re- 
moving the animal in profound shock from the in- 
creased pressure in the tube, death usually occurred 
earlier than the estimated time of living in the tube. 
The same was true of animals bled to the danger- 
point. Intestines that were livid from manipulation 
and exposure prior to the application of the pressure 
in the tube became markedly paler under the pressure, 
and on the removal of the pressure they assumed 
their previous color. The heart-rate was slightly 
lessened on increasing the atmospheric pressure. 
The length of stroke was slightly diminished as 
the pressure rose. On releasing the pressure, the 
pulse-rate, the length of stroke, and the blood-press- 
ure resumed their former status. The respirations 
were slightly affected. To test the influence of in- 
creased atmospheric pressure upon the rate of ab- 
sorption of fluids, normal saline was injected into 
the peritoneal cavity and under the skin, in meas- 
ured quantities. The rate of absorption under press- 
ure did not seem to vary from the controls. Autopsy 
showed nothing abnormal. In no instance were there 
any air-bubbles in the blood. There was no hemor- 
rhage and no congestion. 

Second. — On the effect of diminished atmospheric 
pressure. 

The general trend of the pressures was on parallel 
lines, and the reverse of the preceding. The intra- 
cranial pressure did not fall as low as the intra- 
abdominal. The autopsies did not reveal any char- 
acteristic changes. 

Third. — On the effect of inhaling air under an in- 
creased pressure while the remainder of the body 
ivas under normal pressure. 



ON THE BLOOD-PRESSURE IN SURGERY. 285 

The immediate effect, within certain hmits, of in- 
creased pressure was to diminish the height of the 
pulse-wave. When the pressure was raised suffi- 
ciently to produce pressure against the smaller vessels 
in the walls of the alveoli, higher than the pressure 
within these blood-vessels, the entire circulation was 
blocked; the blood-pressure fell abruptly to the ab- 
scissa, and the heart stopped. The effect upon the 
circulation was directly proportional to the increase 
in the pressure of the air the animal inhaled. At the 
autopsies air-bubbles were found in the blood, in the 
heart, and in the smaller arteries of the mesentery, 
as well as in the spinal cord. The latter were most 
strikingly demonstrated by placing the mesentery 
upon an incandescent bulb, thus showing the air bub- 
bles in strong relief. 

Fourth. — Om the effect of breathing air at the nor- 
mal pressure while the remainder of the body was 
subjected to an increased atmospheric pressure. 
This was accomplished by making a communication 
between the tracheal tube and the outside air while 
the animal was in the pneumatic cylinder. Increasing 
the pressure upon the surface of the animal by in- 
creasing the atmospheric pressure in the pneumatic 
tube was followed by a rise in the blood-pressure. 
The length of the strokes on the writing style (height 
of the pulse wave) increased in a direct ratio with the 
increase of the pressure in the tube. The rise of the 
systolic pressure almost paralleled the pressure in the 
tube. The diastolic pressure rose but little. The dif- 
ference between the systolic and the diastolic press- 
ures (or extremes of the pulse-wave) was in some 
experiments as much as 50 mm., but allowance must 
be made for the inertia of the mercury. The respi- 
ration in every instance promptly became labored and 
failed early. The heart became increasingly slowed; 
i.e., the rate of the heart-beat bore an inverse ratio. 



286 ON THE BLOOD-PRESSURE IN SURGERY. 

and the increase in the length of the pulse-wave a 
direct ratio, to the increase in the atmospheric press- 
ure. When the pressure was continued beyond a cer- 
tain point, the animal died. Life continued one min- 
ute or more, according to the height of the pressure 
in the tube; the heart beat slower and slower, finally 
stopping suddenly in diastole. Animals reduced to 
such a degree of shock that the length of the excur- 
sion of the writing style (pulse- wave) was reduced 
to a minimum, indicating that but little blood reached 
the heart. When animals in such a degree of shock 
were subjected to this experiment, the amount of 
blood that reached the heart was increased in propor- 
tion to the increase in the pressure in the tube, and 
the almost imperceptible pulse-wave became propor- 
tionately larger. The systolic pressure was more 
markedly increased than the diastolic. The animals 
died of cardiac and respiratory break-down, as in 
those previously described. Immediate autopsy 
showed the heart and pulmonary vessels to be mark- 
edly distended. 

On the Effect of Increased Atmospheric Pressure upon 
Absorption. 

In another series of experiments in which saline 
solution was injected into the subcutaneous tissues 
of the abdomen, part of the animals were placed in 
the atmospheric pressure for a given time, the re- 
mainder were left outside for a like period of time, 
as controls. In another series a given quantity 
of saline solution was injected into the peritoneal 
cavity ; some of the dogs were placed under pressure 
and some were left outside as controls. In still an- 
other series the spinal cord was severed, and injection 
of normal saline was made into the peritoneal cav- 
ity. Some of the dogs were placed under pressure 
and some were left outside as controls. 



ON THE BLOOD-PRESSURE IN SURGERY. 



It was intended in these experiments to determine 
whether or not the external pressure caused any 
change in the rapidity of the absorption of normal 
saline when injected into the subcutaneous tissues 
or into the peritoneal cavity, and whether or not the 
absorption would be as rapid under pressure, in the 
cases in which the cord was severed. Later, in look- 
ing over these experiments, it was found that the 
different animals in the controls, as well as those 
in the experiments, gave such widely different re- 
sults that the whole matter was left in doubt. It 
would seem, however, that the injection into the sub- 
cutaneous tissues was absorbed more rapidly in the 
control dogs than in those under pressure. As to the 
peritoneal cavity and spinal cord series, no definite 
conclusions could be drawn from the data obtained. 

On the Effect of alternately and simultaneously varying the 
Pressure of the Inspired Air and the Pressure upon the 
Remainder of the Body. 

Summary of Experimental Data. — When the pressure of 
the inspired air was raised higher than the pressure 
upon the remainder of the body, the pulse-wave be- 
came shorter ; when the pressure upon the remainder 
of the body was raised higher than that of the air 
inhaled, the pulse-wave became longer. It was not 
possible in cases of shock to so adjust the two press- 
ures that the mean blood-pressure could be raised and 
evenly sustained. Either the increase in the press- 
ure in the inspired air interfered with the pulmonary 
circulation or the increase in the pressure upon the 
remainder of the body caused an excess of blood in 
the heart and the pulmonary vessels. In the pneu- 
matic chamber in Lakeside Hospital a number of 
observations concerning the previous experiments 
were made. Although designed for clinical tests it 
was, on account of the difficulties of compression 
and depression, found impracticable. 



288 ON THE BLOOD-PRESSURE IN SURGERY. 



Mechanical Pressure. 

Experimental Data. — Compressing the paw with the hand 
caused a sHght rise in the blood-pressure; bandaging 
the extremities, a proportionately greater rise; press- 
ure upon the abdomen caused a rise in proportion 
to the force and area of compression, but in the 
cases in which the extremities were not bandaged, 
a compensatory fall followed; compressing a vein 
caused a temporary fall; compressing an artery 
caused a rise which was early followed by a partial 
or a complete compensation; any localized pressure 
upon a vascularized tissue caused a temporary rise, 
which was sustained by applying an even pressure 
upon the area supplied by the vessels compressed; 
bandaging from the toes upward caused and main- 
tained a rise in the blood-pressure. The height 
of the rise was directly proportional to the area 
compressed, and within certain limits the force of the 
compression. Pressure upon the thorax embarrassed 
the respiration. If considerable pressure was exerted 
upon the abdomen near the diaphragm, the respira- 
tions became embarrassed. Removal of the external 
pressure was followed by a fall in the blood-pressure. 
The fall in many instances was less than the rise. 
In most instances it was equal to the rise, and in a 
few greater than the rise. There were no evidences 
of unfavorable side effects. 

The Pneumatic Rubber Suit. 

As previously stated, the pneumatic chamber at Lake- 
side Hospital proved to be impracticable. After 
numerous experiments, a pneumatic suit (Fig. 47) 
was constructed of a double layer of specially made 
rubber, which, when inflated, exerts a uniform press- 
ure upon the surface, constituting an artificial periph- 
eral resistance. It is so constructed that one or more 



ON THE BLOOD-PRESSURE IN SURGERY. 289 

limbs or the abdomen may separately or in any combi- 
nation be subjected to pressure by inflation by means 
of a bicycle-pump. The air-valves are so adjusted 
that the rate of decompression may be completely con- 




FiG. 47. — Pneumatic rubber-suit. 



trolled. The effect of the suit upon the blood-press- 
ure may be checked by means of a sphygmoma- 
nometer. The general blood-pressure may be varied 
at will within a range of 25 to 75 mm. of mercury. 
The rise has been sustained as long as twelve hours. 
In the late stage of fatal acute infections, there was 
but little benefit, although the blood-pressure could 
be raised. In operations upon the head and neck 
which are likely to be attended by dangerous shock 
and collapse, the pneumatic suit is put on the patient 
prior to the operation. The circulation of the patient 
is considered, and a certain level is decided upon at 
which the blood-pressure shall be maintained. An 
experienced assistant is detailed to watch the blood- 
pressure by means of the sphygmomanometer. If 
the pressure falls to the lowest level of estimated 
safety, the pneumatic suit is gradually inflated. By 
inflation and deflation the blood-pressure may, within 
certain limits, in the heaviest operations, be main- 
tained at a given level. At the close of the operation, 
and so long as necessary, the blood-pressure is 
watched, and deflation gradually made. In a laryn- 
19 



I 



290 



ON THE BLOOD-PRESSURE IN SURGERY. 



gectomy with extensive resection of the lymphatic 
bearing tissue of the neck moderate shock developed. 
The blood-pressure was raised by means of the rubber 
suit, which soon sprung a leak ; note the fall in pressure 
in Fig. 72. The influence of the pneumatic suit upon 
the blood-pressure was strikingly demonstrated in a 
pulseless case in which the blood-pressure was raised 
to no mm. Having reached this register, the suit 
broke, it being under a considerable pressure, and the 
blood-pressure fell from no mm. to the pulseless con- 
dition below 40 mm., the patient becoming uncon- 
scious. In another case, during an extensive operation 
for cancer of the tongue and of the glands of the neck, 
the blood-pressure fell from 140 mm. to 112 mm., 
and the normal blood-pressure was restored by in- 
flating the suit. After the operation, deflation was 
gradually made during several hours. The patient's 
circulation was thought to be satisfactory. There 
was a considerable oozing in the back part of the 
floor of the mouth which became troublesome. The 
head and shoulders were elevated, syncope imme- 
diately occurred. ( See Fig. 94. ) The rubber suit was 
at once inflated and the syncope as rapidly disappeared. 
A back-rest was then arranged and the patient was 
placed in a semi-sitting posture without ill effect. 
The oozing ceased, and later the patient was placed 
in a horizontal posture and the suit slowly deflated. 
In the falling of the blood-pressure, occurring towards 
the fatal issue of acute infection, the application of 
the pneumatic suit was of little or no benefit. In 
operations upon the head or neck in which the sitting 
or the reclining posture is desired, by means of the 
pneumatic suit, the bulk of the blood may be kept 
circulating in the thorax, neck, and head. This 
posture is of marked importance in such cases as 
removal of the gasserian ganglion, etc., in which ve- 
nous hemorrhage is most troublesome. The recovery 



ON THE BLOOD-PRESSURE IN SURGERY. 291 

of the blood-pressure on inflating the pneumatic suit 
is often striking. The effects may be readily noted 
in the superficial circulation of the face. If continued 
for some time, especially after the condition of the 
patient has improved, the pressure may become an- 
noying. 

On the Resuscitation of Animals apparently Dead. 

(a) Preliminary Statement. — Research heretofore has been 

directed principally towards the resuscitation of the 
isolated heart. The restoration of the fvtnction of the 
vasomotor and other centres, while of equal impor- 
tance in resuscitating the entire animal, has received 
but scant attention. The present research was di- 
rected towards the resuscitation of the entire animal. 
First. By mechanical, therapeutic, and electric stimu- 
lation of the heart, in conjunction with artificial respi- 
ration. 

Secondly. By alternating the posture, head down and 
head up, in rapid succession, alone and in conjunction 
with the preceding. 

Thirdly. Artificial respiration, rhythmic pressure 
upon the thorax over the heart, and intravenous ad- 
ministration of adrenalin. 

(b) Brief Statement of Previous Research. — Arnaud bled a 

rabbit until its heart ceased beating. After the lapse 
of ten minutes, warm defibrinated blood was injected 
into the aorta towards the heart. Regular contrac- 
tions, which continued for some time, almost im- 
mediately appeared. The blood-pressure was not 
restored. 

Hedon and Giles, as stated by Langendorff, repeated 
this experiment on the heart of an executed criminal 
about one hour after his execution. There was then 
no response to irritations. But on injecting warm 
arterial blood into the coronary arteries, distinct 
rhythmical pulsations of the auricles and right ven- 



ON THE BLOOD-PRESSURE IN SURGERY. 



tricks appeared. An identical result is reported by 
these oljservers to have been obtained in a dog. In 
neither the man nor the dog was the circulation 
restored. 

Langendorff, in similar experiments, found that an 
apparently dead heart would resume energetic and 
frequent contractions by the infusion of arterial blood. 
It is said that these attempts were always attended 
with success, providing that the heart was not in 
rigor. In one case a cat could not be resuscitated by 
the usual means from a chloroform death. Two 
hours after the removal of the heart from the body 
it resumed contractions on the injection of warm 
arterial blood. 

In a recent communication (1902) Kuliabio pre- 
sents the most complete treatise on this subject which 
has yet appeared. With the injection of Locke's 
fluid, which contains the same mineral ingredients 
as the blood and 0.4 per cent, dextrose, and which 
has been shown to greatly prolong the duration of 
action of the isolated mammalian heart, the isolated 
rabbit's heart, after it had ceased beating for ten, 
fifteen, and twenty minutes, resumed pulsation. In 
another experiment, the action of the heart had been 
interrupted for twenty, twenty-one, and twenty-five 
minutes respectively, and again resumed contrac- 
tions. After this it was covered with snow for two 
minutes. The heart-beats then ceased. With the 
removal of the snow they reappeared, being now 
even stronger although less frequent than before. 
Subsequent to this, the heart was allowed to remain 
in a cold atmosphere over night. Upon renewing 
the circulation with Locke's fluid, the following morn- 
ing, the contractions immediately reappeared around 
the region of the inferior vena cava, and later they 
also extended over the auricles. 

In another experiment, a rabbit's heart which had 



ON THE BLOOD-PRESSURE IN SURGERY. 293 

lain on ice for eighteen hours was also subjected to 
this artificial circulation. Within half a minute for- 
cible rhythmical contractions in the region of both 
vena cavae appeared, which soon extended over the 
auricles. After about half an hour, strong rhythmic 
contractions of the right ventricle also appeared. The 
left ventricle remained quiescent. The pulsations of 
the heart were during this time (three hours) irregu- 
lar, in that after six or eight weaker contractions a 
stronger one followed. Four and one-half hours after 
the beginning of the experiment the contractions 
ceased, and neither electrical nor mechanical stimula- 
tions were effective. 

The longest period of cessation of cardiac action after 
which the heart again resumed its function, is stated, 
in the case of the cat's heart, to be twenty-four hours. 
It was during this time placed in a refrigerator. A 
rabbit's heart similarly exposed for forty-four hours, 
again resumed its contraction for a period of over 
three hours. 

While these experiments have all been practised in 
the isolated heart, resuscitation of this organ in situ 
is reported to have been accomplished by Watson, 
after its cessation from chloroform narcosis. In a 
series of experiments on dogs to determine the feasi- 
bility of puncturing the heart or cardiocentesis, in 
death from chloroform, it is stated that out of sixty 
experiments the heart failed to resume its action in 
only two instances. The average time which elapsed 
in these experiments between the cessation of the 
heart's action and the introduction of the instrument 
was one minute and twenty seconds, the longest 
period being two minutes. In but two of these sixty 
experiments was the circulation re-established. 
In the remaining experiments, the action of the heart 
aroused by the puncture persisted but a few minutes. 
Prior to my own experiments, Professor George N. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Stewart made experiments upon resuscitation by the 
use of adrenalin in Locke's solution infused into the 
aorta. Respiratory action and some feeble heart-beats 
were noted, but the animals did not recover. 

On Resuscitation. 

Summary of Experimental Data. — When asphyxia caused 
failure of the heart and respiration, vigorous arti- 
ficial respiration usually restored their function v^hen 
administered within a few seconds. It was effective 
in an inverse ratio to the time that had elapsed ; it 
was rarely effective after forty seconds. By the addi- 
tion of saline infusion a larger proportion of animals 
could be resuscitated after the lapse of a little longer 
time. 

Rhythmic pressure upon the heart, either through the 
thorax by pressure upon the ribs over the heart or 
direct pressure within the thorax, was also an aid. 
The effect of the traumatism to the heart by the 
direct method partially counterbalanced the benefit 
from this measure. Nitroglycerin, alcohol, and digi- 
talis were useless ; rapidly alternating the posture, 
head up, then head down, was not effective. Sus- 
pending the animal head down and making rhythmic 
pressure upon the heart was an effective method. 
This method gave the brain the advantage of 
gravity; it provided a moderate artificial circula- 
tion as well as respiration. It could be promptly 
applied. The addition of saline infusion increased 
the effectiveness of the method. 
Animals apparently dead for periods up to fifteen 
minutes were resuscitated by the combined effect of 
artificial respiration, rhythmic pressure upon the 
heart, and the infusion of adrenalin. When the 
blood-pressure had risen to thirty or more mm. Hg. 
the heart began to beat and the blood-pressure was 
rapidly restored. The return of respiration was 



ON THE BLOOD-PRESSURE IN SURGERY. 



signalled by a short, almost imperceptible movement 
of the diaphragm, the respiratory action becoming 
gradually stronger and more frequent. The con- 
junctival reflex returned early. Some of the ex- 
periments failed on account of too great elevation of 
the adrenalin bottle; some on account of an over- 
dose of adrenalin ; several were only partially suc- 
cessful, owing to too great dilution of the adrenalin. 
In the experiments in which lo minims of adrenalin 
in I to looo concentration were injected an over- 
stimulation occurred. Adrenalin, when injected di- 
rectly into the chamber or into the wall of the heart, 
caused fibrillar contractions, after which the heart 
could not be resuscitated. After final cessation of 
the heart, by employing manual compression of the 
heart and infusing adrenalin, the blood-pressure 
could be raised even higher than the normal. Res- 
piration in some instances was partially restored. 
In some of the animals considerable bruising of the 
spleen was noted. In the recovery experiment the 
animal showed restoration of all its ordinary func- 
tions. In experiments in which the heart was di- 
rectly observed through a window in the chest during 
its gradual cessation, the waves of contraction of the 
venous trunks were last to disappear, and earliest to 
reappear when resuscitation occurred. A dog that 
had been apparently killed by the shock of an alter- 
nating electric current of 200 volts, applied by means 
of large moist sponge electrodes in the anus and in 
the mouth, was resuscitated, at least as far as the 
recovery of the circulation and respiration. 
Experiments in which saline infusion was substituted 
for adrenalin, and which were unsuccessful, were 
promptly successful on adding adrenalin. 
In a patient with crushed skull admitted to Lakeside 
Hospital, and whose heart had ceased beating for 
nine minutes, resuscitation of the heart for thirty- 



296 ON THE BLOOD-PRESSURE IN SURGERY. 

one minutes by this method was made. During the 
operation for the elevation of the depressor bone the 
patient moved his head. 

On the Effect of an Increased Heart Action upon the Blood- 
Pressure. 

Summary of Experimental Data. — Severing the vagi 
caused an increase in the rate and probably in the 
force of the heart-beats. In normal animals a rise 
of 10 to 12 mm. usually occurred. In animals in 
shock, the deeper the shock the less the rise on sever- 
ing the vagi. When the shock had reached such a 
degree that stimulation of the sciatic nerve, burning 
the paw, and physiologic doses of strychnin caused 
no rise in the blood-pressure, severing the vagi caused 
none. In recently dead animals in which the periph- 
' eral resistance was maintained by intravenous ad- 
ministration of adrenalin, and the cardiac action by 
rhythmic pressure upon the heart, an increase in the 
force and frequency of the compressions caused an 
immediate rise in the blood-pressure which could be 
only partially sustained ; the net gain varied from 
5 to 15 mm. The blood-pressure in these animals 
could by the administration of adrenalin and manual 
compression of the heart be raised much higher than 
the normal ; without adrenalin the pressure by means 
of compression with the hand as forcibly and rapidly 
as possible and the simultaneous administration of an 
equal amount of saline solution sustained a pressure 
varying from several to 15 mm. In the experiments 
with an artificial circulatory apparatus, consisting of 
an iron cylinder through the perforations in the wall 
of which rubber tubes formed a double communica- 
tion between an extremely elastic rubber bag in the 
cylinder (representing the peripheral resistance area) 
and a rubber bulb with competent valves on the out- 
side (representing the heart), by altering the atmos- 
pheric pressure in the tube the peripheral resistance 



ON THE BLOOD-PRESSURE IN SURGERY. 



could be correspondingly altered. The force and fre- 
quency of the heart-beats were represented by vary- 
ing the force and frequency of the compression of the 
bulb (heart). The arterial pressure (rubber tubing 
leading from the bulb) was recorded by means of a 
mercurial manometer. An increase in the force and 
frequency of the heart (compression of the rubber 
bulb) caused an immediate rise in the blood-pressure 
(rubber tube leading from the bulb). The imme- 
diate rise could only be partially sustained. The 
pressure could not be sustained higher than lo mm. 
by the greatest possible force and frequency. The 
peripheral resistance remained the same. On in- 
creasing and diminishing the peripheral resistance 
the arterial pressure rose and fell, and paralleled pre- 
cisely the pressure in the tube; variations in the 
force and frequency of the heart (compressions of 
the bulb) during the variations in the pressure (pe- 
ripheral resistance) did not maintain an alteration 
of more than lo mm. 

Collapse. 

Summary of Experimental Data. — In collapse caused by 
asphyxia or hemorrhage, stimulating the sciatic 
nerve, burning the paw, and administering physio- 
logic doses of strychnin were attended by a rise in 
the blood-pressure. This occurred in cases in which 
the pressure had fallen as low as in the cases of 
shock in which such stimulation caused no change 
in the pressure. On raising the pressure by saline 
infusion in profound collapse, Traube and other vaso- 
motor curves usually appeared. At first there were 
long sweeping curves, then shorter, and finally they 
disappeared. During the development of fatal as- 
phyxia, vasomotor curves of increasing length ap- 
peared and continued until the blood-pressure began 
the decline of the final breakdown. During this final 



298 ON THE BLOOD-PRESSURE IN SURGERY. 

Stage the strokes were at first very long, then gracki- 
ally diminished until the heart stopped. The charac- 
teristics of the faUing curve in approaching death in 
certain forms of collapse are reversed in the rising 
curve of restoration. Normal saline infusion was 
usually attended by a well-marked rise which was in 
most instances well sustained. 

On removal of the cause of the collapse, or on the 
application of the means for restoring the normal 
blood-pressure, the circulation was, within physio- 
logic limits, automatically continued. 

On the Nature of Traumatic Shock. 

Additional Experimental Data. — In all the experiments in 
which pure shock was produced it was found that a 
considerable time was required, usually half an hour 
or more. The extent of the rise in the blood-pressure 
on stimulating the sciatic nerve and burning the paw 
gradually diminished as the blood-pressure fell, and 
finally, when the stage of most profound shock was 
reached, usually when the blood-pressvire had fallen 
to approximately 20 mm., stimvilation of the sciatic 
nerve or burning the paw produced little rise in the 
blood-pressure. The extent of the rise in the blood- 
pressure following the intravenous administration of 
strychnin diminished with the development of shock, 
and when the deepest degree had been reached (that 
is, when the blood-pressure had fallen to approxi- 
mately 20 mm. and stimulating the sciatic nerve and 
burning of the paw caused no rise) strychnin in the 
curarized animals caused no rise in the blood-press- 
ure. In the non-curarized animals there was an 
irregular slight rise, wiiich continued only during 
the convulsions. After each dose of strychnin, large 
enough to cause any effect, the animal passed into 
a deeper degree of shock. In the animals in which 
the heart was isolated from the central ner\-ous sys- 



ON THE BLOOD-PRESSURE IN SURGERY. 



tern by severing both vagi and both accelerantes, 
shock was as readily induced as in the controls. The 
rise in the blood-pressure on stimulating the sciatic, 
or burning the paw, or administering strychnin cor- 
responded fairly well to that of the normal animal ; 
the gradual diminution and final disappearance of 
the efifects of these were similar to those in the con- 
trols. In every degree of shock in the animals in 
which the vagi and the accelerantes were intact, and 
in those in which both had been previously severed, 
adrenalin caused a rise in the blood-pressure propor- 
tional to the dose. The rise following adrenalin was 
but slightly modified by the degree of shock. In 
some of the experiments of the series in which the 
animals were reduced to such a degree of shock that 
stimulation of the sciatic nerve, burning the paw, 
and administering a physiologic dose of strychnin 
did not cause any rise, the splanchnic nerves were 
severed and both the central and peripheral ends 
were stimulated by placing them in contact with the 
electrodes of a Dubois-Raymond coil. No change in 
the blood-pressure from the stimulation of the cen- 
tral ends was noted. In certain experiments some 
rise followed the stimulation of the peripheral ends. 
No variation in the susceptibility of the animals under 
curare and artificial respiration as compared with the 
controls was noted. In the experiments in which 
the medulla was cocainized by dropping the solution 
upon its surface, or by injections into its substance, 
the blood-pressure fell to 40 or 50 mm. In such ex- 
periments the usual procedures for producing shock 
caused but little effect. In the experiments in which 
collapse occurred early — e.g., from over-anesthesia, 
from hemorrhage, from asphyxia, from too rapid ad- 
ministration of curare, etc. — an increased suscepti- 
bility to shock was noted. In the cases of deepest 
shock in which the blood-pressure was raised higher 



ON THE BLOOD-PRESSURE IN SURGERY. 



than the normal by adrenalin, the heart performed 
its function normally. In such cases mechanical 
stimulation of the laryngeal mucosa caused a reflex 
inhibition of the heart and respiration. 

CLINICAL OBSERVATIONS ON BLOOD-PRESSURE. 

The determination of the blood-pressure in the hu- 
man being for the purpose of clinical study has been 
variously contemplated by a number of different ob- 
servers. All these methods have for their basic prin- 
ciple the force that is required for the obliteration 
of the pulse, this being directly derived from the 
common usage of measuring the arterial tension by 
means of digital compression. Vierordt, in 1855, is 
stated to have measured more accurately the force 
required for the obliteration of the pulse, by means 
of a sphygmograph, of which he stated that absolute 
values, as to the tension of the arteries, could not be 
obtained. 

N. V. Kries, in 1875, determined the capillary ten- 
sion in the human being, by causing a pallor of the 
integument, by means of the pressure of known 
weights. Marey, in 1 786, applied the same principle, 
by enclosing the entire arm in a glass cylinder, then 
compressing the contained air to a point sufficient 
to produce pallor. The blood-pressure, as deter- 
mined by this method, corresponded to a point mid- 
way between the pressure of pallor and of flushing. 
In later investigations hydrostatic pressure was em- 
ployed instead of air-pressure, as well as a mercury 
manometer for the registration of the oscillation of 
the piilse. The maximum pressure was then deter- 
mined by increasing the pressure till all oscillations 
of the pulse ceased. According to later investigators, 
this method is stated to be quite faulty (Breuer, 
Basch, Recklinghausen). 

In still later attempts Marey inserted only a finger 



ON THE BLOOD-PRESSURE IN SURGERY. 301 

in a cylinder ; this seemingly did not insure greater 
efficiency. 

Ray and Brown, in 1878, then measured the blood- 
pressure by placing a membrane, stretched over a 
capsule, upon the skin and applying air- or water- 
pressure. The capsule was connected with a water 
manometer. A distinct advantage is stated to be pos- 
sessed by this method as the obliteration of the ves- 
sels could be accurately determined macroscopically. 
Waldenburg, in 1880, again employed the method of 
Vierordt, rendering it somewhat more serviceable. 
Among the methods which have since appeared, all 
of which have been variously employed by the dif- 
ferent investigators, there are: 
1 88 1. The method of v. Basch. 

1895. The method of Mosso. 

1896. The method of Hvtrthle. 
1896. The method of Riva Rocci. 
1896. The method of Hoepfle. 

1898. The method of Hill and Bernard. 

1899. The method of Oliver. 
1899. The method of Gaertner. 
1903. The method of Stanton. 

The sphygmomanometer of v. Basch consists of a 
glass tube divided into centimetres. It is expanded 
into a bulb at its lower extremity. This bulb is en- 
cased in a glass cylinder below which a membranous 
bulb is attached. The bulb and cylinder communi- 
cate b}' a small opening in the former, which in part 
contains mercury and in part water, while the glass 
cylinder is completely filled with water. The press- 
ure exerted on the membrane is transmitted by the 
watery medium to the mercury, the degree of press- 
ure being then indicated by the number of centimetres 
to which the mercury rises in the tube. To determine 
the amount of the blood-pressure, the instrviment is 
applied over an artery, such as the radial, and press- 



ON THE BLOOD-PRESSURE IN SURGERY. 



lire is then applied up to the point at which the dis- 
appearance of the pulse, peripheral to this point. 



C 




Fig. 48.— Hurthle apparatus; schematic. B, bandage around arm: C, cylin- 
der ; M, manometer. 



occurs. Having caused the disappearance of the 
pulse, by this instrumental compression of the artery, 




Fig. 49.— Hurthle apparatus. Glass cylinder for insertion of the arm. 

the pressure is gradually diminished until the pulse 
again reappears, this being the point which is sup- 
posed to indicate the blood-pressure. 



ON THE BLOOD-PRESSURE IN SURGERY. 



In Hurthle's method of determining the blood-press- 
ure (Figs. 48, 49, and 50) the forearm is first ex- 
sanguinated by the appHcation of a rubber band; 
the blood is then excluded from this part by a second 




Fig. 50. — Hiirthle apparatus. 



bandage applied around the arm ; the body of the 
forearm is thereby diminished, this diminution being 
equal to the blood and lymph which has been pressed 
out by this process. In this condition the forearm 
is placed in a glass cylinder, being encased therein 
in a rubber sleeve, this serving for a more complete 
hermetical sealing of the part. The space between 
the arm and cylinder is next filled with water which 
has been freed from all air by boiling and the band- 
age around the arm is removed. The pressure is 
now determined by means of a manometer, which is 
connected to the glass cylinder, and which records the 
values of the blood-pressure on the drum, as seen in 
the accompanying illustrations. 



ON THE BLOOD-PRESSURE IN SURGERY. 



The instrument of Hoepfle (Fig. 51) consists of two 
cylinders, one of which is enclosed within the other; 




Fig. 51. — Hoepfle blood-pressure apparatus. 



the internal movable cylinder (a) in its turn encases a 
spiral spring which rests upon the floor of the exter- 
nal cylinder. Pressure exerted on the upper surface 
of the external cylinder compresses the spring, the 
amount of this compression being measured by an 
indicator by means of an enclosed cog-wheel. The 
lower end of the instrument consists of a rubber bulb 
filled with glycerin. In the application of this instru- 
ment the bulb is placed over the middle of a suitable 
artery, such as the temporal or radial, and pressure 
then applied to the point at which the pulse periph- 
eral to the point of compression disappears. 
The Riva Rocci sphygmomanometer (Figs. 52 and 
53), as described by Stanton, consists essentially of 
three parts : " A flat rubber bag or tube, about 40 cm. 
in length and 4 cm. in width, covered on the outer sur- 
face with canvas, to prevent expansion outward. One 
end of this tube is kept permanently closed by the 
special clamp, while the other end is pressed by a lever, 
worked with a screw adjustment, after the tube has 
been properly fitted to the upper arm of the patient. A 
metal tube passing through the clamp serves to con- 
nect the interior of the tube to the remainder of the 



ON THE BLOOD-PRESSURE IN SURGERY. 




ON THE BLOOD-PRESSURE IN SURGERY. 

apparatus. The second part is a mercury manometer, 
the scale of which will register at least 300 mm. The 
third part is the air-pipe, which in this case is a rub- 
ber syringe of the type furnished with the thermo- 
cautery (Cushing's modification). These three parts 
are connected to three limbs of a four-way glass con- 
nection. To the fourth limb is attached a short 
rubber tube closed with a spring clip, by means of 
which the air can be allowed to escape after the 
pressure has been determined." In the application 
of this instrument the rubber armlet is fitted around 
the arm above the elbow, the muscles being in a 
state of relaxation and the constriction occurringf at 
about a level with the heart. As the air enters the 
armlet, it compresses the arm with a force that is 
measured by the height of the mercury column, and 
this compression is transmitted through the soft 
tissues to the artery. As the pressure increases, the 
pulse disappears. Either this point of disappearance 
of the pulse or the point at which the pulse reappears 
after compression, is read off the manometer scale as 
the pressure. Cushing's modification of the Riva 
Rocci instrument, whereby a thermo-cautery bulb for 
rapid inflation and a special clip for releasing the 
pressure are added, renders more frequent observa- 
tions possible and greatly increases its usefulness. 
The Hill-Barnard sphygmomanometer (Fig. 54) con- 
sists of " (i) a leather armlet, inside of whicli is fast- 
ened a flaccid rubber bag; (2) a force-pump provided 
with an escape-valve ( A) ; and (3) a pressure-gauge 
graduated in millimetres of mercury. In using the 
instrument the method is as follows : ( i ) the armlet is 
strapped firmly around the upper arm ; the rubber bag 
is thus brought into close contact with the skin ; 
(2) the extra tube of the rubber bag is connected by 
means of a T-tube with a pump and the pressure- 
gauge; and (3) the pressure is raised within the 



ON THE BLOOD-PRESSURE IN SURGERY. 307 

rubber bag and gauged by means of a ptmip until the 
point is found where the index of the gauge exhibits 




Fig. 54.— Hill- Barnard sphygmomanometer. 



the maximum cardiac pulsation. This point indi- 
cates the mean arterial tension." 
Oliver's hemadynamometer (Figs. 55, 56, 57, and 58) 
consists of two principal parts, — ( i ) the pad and (2) 




Fig. 55. — Oliver's hemadynamometer. a, the rubber pad; b, the recorder. 

the recorder, — the former of which is made of thin 
rubber, it being small and cylindrical in shape and en- 
circled by a metal rim. The convex lower end of the 
pad projects beyond the rim so that when applied over 



ON THE BLOOD-PRESSURE IN SURGERY. 



the vessel only a soft rubber is brought in contact with 
the skin. At its upper end a stem connects with the 
circular spring of a recorder. The pad is filled with 
fluid water, brought up to an average of specific 
gravity of serum (1030) by the addition of glycerin. 
The recorder is a circular box, two inches in diam-. 




Pjc. 56— Mode of applying Ihe hemadyiiamometer to the radial artery on 
rest with screw adjustment. 

eter, containing a circular spring which receives the 
pulsations transmitted through the fluid pad. In 
the application of this instrument the pad is placed 
over the artery and pressure is then applied. The in- 
dicator begins to pulsate after denoting a pressure 
of 50 mm., and the pressure now being steadily in- 
creased, the pulsations gradually become larger until 
they attain the maximum excursion, from which 



ON THE BLOOD-PRESSURE IN SURGERY. 




Fig. 57. — Mode of applying the hemadyiiamometer to the carotid artery. 




Fig. 58. — Mode of determining the venous pressure with the hemadynamometer applied by 
means of a screw adjustment. 



ON THE BLOOD-PRESSURE IN SURGERY. 



point, as the pressure is carried farther, they as 
gradually diminish, the progressive rise and fall in 
the motion ]>eing perfectly equable throughout. The 
mean arterial blood-pressure is indicated when the 
maximum motion is obtained, the reading being 
made at the point between the two minutes of the 
excursion. The maximum arterial pressure is re- 
corded when the pulsation of the artery beyond the 
pad is obliterated. 

Gaertner's tonometer (Fig. 59) consists of a pneu- 
matic ring about i cm. in height and 2^ cm. in 




Fig. 59.— Gaertner tonometer, a, larger apparatus ; d, pocket apparatus and 
compressor. 

diameter. This ring is perforated by a metal tube 
which, as illustrated, is connected with both a ma- 
nometer and a compressor. The blood-pressure is de- 
termined as follows : The ring is slipped over the sec- 



ON THE BLOOD-PRESSURE IN SURGERY. 311 

ond phalanx of the finger or over the first phalanx of 
the thumb after the terminal phalanx of the finger has 
been exsanguinated either by means of a thimble-like 
compressor or by a rubber ring which is rolled down- 
ward over the finger. The pneumatic ring is then 




Fig. 60. — Stanton's method for the determination of blood-pressure. 



filled with air at a pressure higher than that of the 
blood and the compressor or rubber band then re- 
moved. The compression of the pneumatic ring is 
now gradually reduced. At a certain moment the 
finger suddenly flushes, the patient at the same time 



ox THE BLOOD-PRESSURE IX SURGERY. 



feeling a distinct throb. This point indicated by the 
manometer is supposed to be identical with the blood- 
pressure. 

Stanton's method (Fig. 60) consists of a rubber arm 
in which the widths of the compressing surface is more 
than twice as large as that of the Riva Rocci or the 
Hill-Barnard methods (three and one- fourth inches 
wide and sixteen inches long). This rubber cuff is 
prevented from expanding outward by a cuff of 
leather or of double-thick canvas re-enforced by tin 
strips. " To the centre of the rubber cuff is cemented 
a rubber valve-stem of the kind used on the inner tube 
of a bicycle tire, through which passes a glass con- 
necting tube, its extremity being flush with the 
inner surface of the armlet. A piece of stiff-walled 
rubber tubing, about one- fourth inch in caliber, con- 
nects the glass tube in the valve-stem with one 
end of the horizontal limb of a glass ' T,' while a 
similar piece of tubing joins the other extremity of 
the horizontal limb to a mercury manometer. The 
vertical limb of the ' T' is connected by a softer tubing 
of the small pump." To determine the blood-pressure 
by this method, the rubber armlet is fitted to the arm 
above the elbow and air is forced through the appa- 
ratus until the pulse is no longer palpable. The air 
is then permitted to escape through the soft tube, 
which is held by the fingers until the pulse reappears, 
and this point is mentally noted as the systolic press- 
ure. The pressure is now reduced a few millimetres 
at a time, and the pulsation in the mercury column 
will increase in size until a maximum is obtained, then 
diminished. The base line of these maximum pulsa- 
tions is noted as diastolic pressure. The mean press- 
ure is the mathematical mean of the two pressures 
obtained. 

These various methods enumerated are in princi- 
ple similar, if not identical, and may all be classified 



ON THE BLOOD-PRESSURE IN SURGERY. 313 

as the indirect method in which the determination 
of the blood is accompHshed by compression of the 
arterial vessels in contradistinction to the direct 
method in which the blood-pressure is measured by 
the insertion of a cannula into the lumen of the ves- 
sel. The latter method has in a few instances been 
practised on man. 

Faiver, according to Zadeck, during amputations, 
determined the blood-pressure in the brachial artery 
of a man sixty years of age, and also in the femoral 
of a man thirty years of age. In both a value of 120 
mm. Hg. was registered. The blood-pressure in the 
brachial artery of a man twenty-three years of age 
was found to be no mm. Hg. Vierordt mentions a 
case in which during an amputation of a leg the 
blood-pressure was found to be 155 mm. Hg. 
As will be seen later, these figures essentially agree 
with those obtained by the various clinical methods 
in the different arteries of the body. 
While this direct method of inserting a cannula within 
the arterial lumen is undoubtedly the method of pref- 
erence, it is not totally devoid of inaccuracy, for the 
reason that in the exposure of the artery the pressure 
of the surrounding tissue is frequently removed, and 
also from the fact that the circulation peripheral to 
the cannula is lost, and which, in consequence, tends 
to raise the blood-pressure in the artery in question. 
While the first of these objections, in experiments in 
which the superficial arteries, such as the carotid or 
the femoral are employed, cannot be considered as 
being of much consecjuence, the latter becomes a dis- 
tinct factor of inaccuracy in the determination of 
normal blood-pressure. In regard to the determina- 
tion of the blood-pressure by means of the various 
clinical methods, this objection is also valid. Reck- 
linghausen has determined that the compression of 
the large artery is in itself a blood-pressure-raising 



314 ON THE BLOOD-PRESSURE IN SURGERY. 

measure. In the compression of the femoral artery 
for a period of ten seconds, he found that the blood- 
pressure rose 2 cm. water, and when the arm was 
compressed for a longer time a distinct rise of the 
blood-pressure gradually occurred. After one min- 
ute the rise of lo cm. water was frequently observed, 
and when compression was prolonged for over one 
and one-half minutes, the rise continued. In one 
instance, after twenty minutes' compression, with 
Hurthle's instrument, the rise of from 140 cm. to 
185 cm. was noted, and after the compression had 
been discontinued for several minutes the pressure 
still measured 155 cm. Recklinghausen, however, 
inclines to the view that the rise of the pressure, as 
produced by compression, is the result of stimulation 
of the vasomotor centres, and is not a peripheral or 
local ef¥ect. 

As to the accuracy of the values obtained by clinical 
methods, several factors have been stated by different 
authors to influence these determinations. These are : 

( 1 ) The resistance offered by the arterial wall. 

(2) The resistance offered by surrounding tissue. 

(3) The cjuantity of blood contained within the ar- 
terial system. 

The resistance of the arterial wall to the compressive 
force was measured by v. Basch on fresh carotids 
of horses and also on the human radial arteries, which 
were obtained soon after death. They noted that the 
kfmen of these vessels was obliterated, when the ex- 
ternal pressure exceeded the internal pressure by but 
a few millimetres ( 1-2-3 mrn- Hg. ). The effect that 
the arterial wall may have on these determinations by 
compression is then furthermore indicated in the ex- 
periments in which sclerotic arteries were employed, 
in which 5 mm. Hg. more of external pressure was 
required to overcome the internal pressure. Whether, 
however, on the living normal artery, on which the 



ON THE BLOOD-PRESSURE IN SURGERY. 315 

tonicity of the muscular layer of the artery is present, 
an excess of the external pressure is required still 
remains doubtful. The living arterial walls tend to 
constantly contract upon the contained column of 
blood, so that the elastic vital force is to be associated 
with the instrumental compression of the vessel. 
While it cannot be definitely said to aid this com- 
pression, it can also not be stated to offer any resist- 
ance. (See Figs. 61 and 62.) 




Fig. 61. — V. Basch sphygmomanometer. 



The manner in which compression affects the artery 
is that its lumen becomes obliterated by the apposi- 
tion of its opposing walls. In this apposition of the 
arterial walls the flattening of the artery ultimately 
results, whereby its lumen is transformed into a linear 



ON THE BLOOD-PRESSURE IN SURGERY. 

slit. The first part of the arterial walls to come in 
apposition is the middle point of what ultimately con- 
stitutes this linear slit, so that the arterial lumen first 




Fig. 62. — Manometer of v. Basch sphygmomanometer. 

assumes an hour-glass-shaped contour. While the 
arterial lumen assumes the hour-glass-shaped type 
the current of blood is not completely interrupted, 



ON THE BLOOD-PRESSURE IN SURGERY. 317 

its floAV still continuing through the two ends, or 
corners, of the vessel. The pulse may still be pal- 
pated as a barely perceptible wave. 
With the obliteration of these two open ends the 
pulse also ceases in the peripheral parts, and it is at 
this moment, when all parts of the arterial walls come 
in contact, that, theoretically, the blood-pressure 
should be determined. 

Of the resistance offered by the surrounding tissues 
of the vessel to compression, and the objections ad- 
vanced as to the inaccuracy of the determinations so 
obtained, it has also been shown not to be a serious 
hinderance. Zadeck states that with the method of 
V. Basch the absolute values obtained in women is 
farther from the normal than in men, owing to 
the thicker panniculus adiposus. Experiments per- 
formed on human cadavers in which the internal 
pressure was a known quantity have led to a similar 
conclusion; in the latter, however, the vital elasticity 
of the tissues is lacking. The living tissues, more- 
over, contain a high percentage of fluids, so that, in 
accordance with hydrostatic laws, the pressure, from 
the compression of a part, can be assumed to be 
equally transmitted in all directions, with but little 
loss. The observations of different clinicians are in 
full accordance with this assumption. It is known 
that the blood-pressure, in distant arteries of differ- 
ent dimensions, such as the radial and femoral, when 
measured by the insertion of a cannula, show but a 
very slight variation, which is readily accounted for 
by the difference in the distance from the heart or 
by the difference in the size of the vessels. In meas- 
urements by instrumental compression the results 
obtained have been parallel. 

Recklinghausen found that, in the simultaneous de- 
termination of the blood-pressure in the upper arm 
and thigh, with his modification of the Riva Rocci 



ON THE BLOOD-PRESSURE IN SURGERY. 



method, the pulse, as fek either at the radial artery 
or at the dorsal artery of the foot, disappeared 
either at the same time or in other instances with a 
very slight difference, whose extremes varied from 
— I to — 4 cm. He concludes that in these obser- 
vations the pulse disappeared in both arteries simul- 
taneously with the same amount of pressure, and 
that the difference mentioned is to be attributed to 
the mistakes in the determinations. The deduction 
reached from these experiments is that the soft parts 
surrounding the arterial vessel do not influence its 
compression, and that the greater width as compared 
with the forearm is of no material difference in the 
determination. 

Gumprecht, on the other hand, had previously to this 
reached a deduction opposed to this. In his observa- 
tions with the Riva Rocci method he states that he 
ascertained that the thicker parts of the body register 
a higher pressure than the thinner parts, and in the 
parts of an extremity in which much osseous tissue 
and but little soft tissue was present, a higher press- 
ure was usually also obtained. In a tabulation com- 
paring the results as obtained in the upper arm, fore- 
arm, thigh, calf, and leg this appears quite striking. 
This disparity in the observations of these two inves- 
tigators has been fully and concisely explained by 
Recklinghausen, who correctly attributes the differ- 
ence to the difference in the width of the cuffs, 
Gumprecht employing the regulation Riva Rocci 
cuff, while Recklinghausen used his modification of 
the same. 

In all of the clinical methods which attempt the de- 
termination of the blood-pressure by the compression 
of an artery, and take as the indication for sufficient 
compression the disappearance of the pulse peripheral 
to this point, the mean arterial pressure is not ob- 
tained. As has been variously stated, the determina- 



ON THE BLOOD-PRESSURE IN SURGERY. 319 

tion of the blood-pressure in this manner corresponds 
to the maximum blood-pressure. As we know, the 
blood-pressure is physiologically in a state of constant 
variation, as is readily denoted in a graphic presen- 
tation of a pulse-tracing. In these oscillations of 
the pulse there can be readily differentiated a point of 
minimum and a point of maximum pressure, which 
are, respectively, the highest and lowest points of the 
pulse-curve. Both have primarily a cardiac origin, 
representing, respectively, the ventricular contraction 
and relaxation. The point of maximum pressure, 
therefore, indicates the systolic pressure, while that 
of the minimum pressure is to be associated with 
the diastolic phase of the ventricular cycle. Midway 
between these two points lies that of the median 
blood-pressure; i.e., the point which has no prepon- 
derant cardiac factor, but which represents a pressure 
in whose production the heart, arterial tension, and 
the volume of the blood are all represented in about 
equal proportions. In the determination of the maxi- 
mum or of the minimum pressure, or both, it can 
be asserted that a conclusion as to the mean press- 
ure can be derived therefrom, although the value so 
obtained is but relative. With the increase in the 
ventricular systolic action, and therefore with the 
increase in the maximum pressure, a simultaneous 
decrease in the ventricular diastole and a minimum 
blood-pressure may or may not occur. In instances 
in which such an increase in the one is not accom- 
panied by a decrease in the other, the mid-point be- 
tween high and low pressure is necessarily disturbed, 
and now lies at a higher position, so that the medium 
pressure is also increased. If, on the other hand, the 
decrease of the minimum pressure coexists with an 
increase in the maximum pressure, the medium point 
between the two may or may not remain stationary, 
according as to whether the decrease in the minimum 



I 



ON THE BLOOD-PRESSURE IN SURGERY. 



pressure is or is not proportionate to the increase in 
the maximum pressure. Tshcelinof¥, as cited by 
Masing, in fact, asserts that during exercise the maxi- 
mum pressure rises simultaneously with the fall of 
the minimum pressure, while the medium pressure is 
slightly altered. He explains this by an increase in 
the cardiac action (increase in the maximum press- 
ure) and a concomitant dilatation of the peripheral 
vascular system (decrease of the minimum pressure), 
so that the medium pressure remained fairly constant. 
Hensen, however, on the contrary, estimates that the 
maximum pressure is a fair indication as to the me- 
'dium pressure. In compressing the abdominal aorta 
below the origin of the renal artery, he found that, 
with the record of a sphygmograph, the mean press- 
ure rose almost proportionately with the maximum, 
and, discounting the slight errors which result in 
the determinations, he concludes that the maximum 
pressure can give a reliable basis for the deduction 
of the mean pressure. 

Masing, also, in his observations, draws a positive 
deduction on the question. He reports the following 
observations in support of the statement of Hensen : 



PULSE-PRESSURE AMPLITUDE IN MM. HG. OBTAINED BY THE 
SPHYGMOGRAPH. 



Pulse-pressure. 
Minimum. Ma.ximum, 



Amplitude. Remarks. 



I. B. K. 19 Rest 

Work 
II. E. K. 21 Rest 



. 125 155 
■ 155 205 
. 95 142 



30 
50 
47 
40 

45 

40 

35 
35 
35 
40 
40 
50 
60 



III. K. J. 68 Rest 



100 140 

no 155 

. no 150 

no 145 

125 150 



After work. 



125 160 

no 150 

110 150 

100 150 

no 170 

135 190 

115 170 



After work. 



IV. D. T. 73 Rest 



After work. 



Work 



55 
55 



ON THE BLOOD-PRESSURE IN SURGERY. 321 
In general there were obtained the following results : 

Pulse-pressure. 4.„„i;»„^<. 
Minimum. Maximum. Amplitude. 

I., II. Rest .... 113 150 37 

Work .... 152 200 48 

III., IV. Rest .... Ill 153 42 

Work . ... 130 198 68 

He concludes from this tabulation that in muscular 
exercise the maximum and minimum and conse- 
quently also the mean pressures are increased, all 
these, however, in different degrees, and that the mini- 
mum pressure is influenced the least. The oscilla- 
tions of the medium pressure are often not exactly 
those of the maximum. On the whole, however, the 
alterations of the maximum pressure are shared by 
the mean pressure, so that the determination of 
one in muscular exercise gives indication as to the 
simultaneous alteration of the other. 
Stanton, however, takes exception to the general con- 
clusion which Hensen derives that the systolic press- 
ure can be used as a guide to the mean pressure, and 
concludes that a reliable means has not yet been found 
to determine the mean pressure. He quotes, in this 
connection, also, the work of Howell and Brush, who 
on dogs were able to produce variation in the high 
and lower pressure without effecting the mean press- 
ure, and who also showed that the mathematical mean 
of the systolic and diastolic pressure approximately 
equalled the mean pressure. 

All of the methods which clinically determine the 
blood-pressure have been stated to have their defec- 
tive qualities. 

To the V. Basch method Waldenburg takes exception, 
stating that, among other objections, it does not 
measure the blood-pressure, but the arterial tension, 
— viz., the blood-pressure, the tension of the arterial 
walls, and the resistance of the overlying tissues. In 
that the tension of the arterial wall remains an un- 
21 



322 



ON THE BLOOD-PRESSURE IN SURGERY. 



known quantity, the determination of the blood- 
pressure is said not to be possible. 
Zadeck, however, concludes that this method does not 
give the absolute value of the blood-pressure, but 
only figures which are probably greater, but which 
approach it the more, the thinner the overlying soft 
tissues are. 

According to Ewald, the v. Basch method is subject 
to mechanical errors. In his investigations as to the 
accuracy of the instrument, the value of the blood- 
pressure is said to have been partly dependent on the 
size of the compressor. Employing a larger-sized 
compressor than that used by v. Basch the blood- 
pressure was found to register less. 
This same objection is advanced by v. Reckling- 
hausen, and it is to be noted that v. Basch has lately 
adopted the larger-sized compressor. Howell and 
Brush, as well as Stanton, also state that this method 
is prone to errors. 

The Hill and Barnard instrument, as well as the 
Oliver's hemadynamometer, has found a limited field 
of application. Both these, as Stanton asserts, are 
based on the theory of Mosso, — viz., that the great- 
est oscillations occur in the arterial wall when an 
external pressure is applied, that just equals the mean 
pressure. Howell and Brush, however, have shown 
on dogs that the greatest vibrations occur at the 
time when the pressure within the artery is low- 
est, so that these instruments really record the dias- 
tolic pressure. Mechanically, also, according to 
Stanton, the Hill and Barnard instrument is faulty, 
in that, owing to the spring soon losing its strength, 
its accuracy soon becomes impaired, etc. 
Riva Rocci, as cited by Hensen, states of his method, 
that the determinations, as obtained thereby, are but 
Yz mm. too high. As a proof of its accuracy he ad- 
vances certain experiments on animals in which the 



ON THE BLOOD-PRESSURE IN SURGERY. 323 

values obtained were higher than the normal by the 
above-mentioned figures. In cadavers he also found 
that the thickness of the musculature did not influ- 
ence the determinations. 

V. Recklinghausen, however, asserts that this method 
is highly inaccurate, and advances, as a much more 
efficient method, a modification of the same, consist- 
ing essentially of a greater width of the cuff em- 
ployed for the compression of the part. Insufficient 
dimensions in the area of compression is held to be 
the cause of the too high values which are obtained 
in most methods, as also in the Riva Rocci method. 
In a simultaneous determination with a regulation 
Riva Rocci cuff 5 cm. wide and one 12 cm. wide, as 
applied on both arms, he reports the following re- 
sults. Circumference of each arm, 24^ cm. 

Broad cuff. Riva Rocci cuff. 

Pulse returns Right upper arm . . goto 96 Left upper arm . . .116 

Pulse returns Right upper arm . . 92 to 100 Left upper arm . . .114 

Pulse disappears . . . Right upper arm . . goto 98 Left upper arm . . .112 

Pulse returns Right upper arm . 92 to 98 Left upper arm . . .114 

Pulse returns Left upper arm . . . 96 to 104 Right upper arm . .118 

Pulse returns Left upper arm ... 94 to 104 Right upper arm . . 120 

Pulse disappears . . . Left upper arm . . . 104 to 108 Right upper arm . . 120 

Average 94 to 104 116 

These errors in the determination are the higher, the 
greater the width of the part. In the correction of 
this error, Recklinghausen states that it becomes ne- 
cessary to procure a cuff which is of sufficient width 
to exclude all errors the varying diameters of an 
extremity may have. He has found by experimenta- 
tion that a length of the cuff of lo cm. is just suffi- 
cient for an arm of 24 cm. in circumference, while 
one of 15 cm. length is sufficient for most all cases, 
and one of 32 cm. length, which includes the arm 
from the axilla to the middle of the forearm, gives 
absolute results in every case. The exact numerical 
width of a cuff can be ascertained by the application 
of several cuffs of different dimensions, the narrowest 



324 



ON THE BLOOD-PRESSURE IN SURGERY. 



cuff, whose results correspond with those of greater 
width, being one which insures sufficient accuracy. 
Hensen, on the other hand, gives the Riva Rocci 
method preference, in that he beheves its subjective 
errors to be small. In experiments on cadavers he 
corroborates the results of Riva Rocci, the values ob- 
tained being but 3^ mm. too high. The musculature, 
if relaxed, was found to cause no errors in the de- 
termination. Contracted muscles as well as edemas, 
however, influenced the accuracy of this method. 
Stanton has lately corroborated the findings of Reck- 
linghausen as to the disparity in the results with the 
narrow and the wide cuff. With the narrow cuff he 
obtained like readings on the arm and the forearm, 
but on the thigh, unless the patient was very thin, the 
readings were higher. With the wide cuff all of the 
readings were practically the same. He concludes, 
that it is evident that the pressure measured by this 
apparatus is the maximum or systolic pressure plus 
any possible tension due to transmission, this possi- 
ble loss being, however, small. " Therefore the con- 
clusion seems to be justified that circular compression 
of the arm by the Riva Rocci method gives an accu- 
rate measurement of the systolic pressure, provided 
the width of the compressing armlet is properly pro- 
portional to the circumference of the arm." 
The Gaertner tonometer, as stated by Reckling- 
hausen, is also inefficient, in that the area compressed 
is not of sufficient width, nor does the compressor 
adapt itself to the finger in a sufficient degree. In 
a compression of greater width, which was applied 
to the basal phalanx instead of the second phalanx, 
this being a pressure more in accordance with tliat 
of the arteries than that obtained farther distant, the 
results obtained were found to vary from those ob- 
tained by the Gaertner method. 



ON THE BLOOD-PRESSURE IN SURGERY. 
The tabulation of these results is as follows : 



325 



Table V. 

Simultaneous blood-pressure measurements on two 
fingers of his own person; sitting three hours after 
noon-day meal; warm day; slight perspiration on 
the forehead. 

Pressure in mm. Hg. The sensation of the throb 
taken as the criterion. 



Left hand, Gaertner's ring. Right hand, new cuff. 



No. 


Index Middle 


Ring Small 


Index Middle 


Ring Small 


Differ- 


finger, finger, finger, finger. 


finger, finger. 


finger, finger. 


ence. 


I. 




82 




82 




0 


2. 


86 






86 




0 


3- 


80 






80 




0 


4- 


100 (After new attempt) 




78 




+ 22 


5- 


90 (After new attempt) 




78 




+ 12 


6. 




76 




76 




0 


7. 


102 






86 




+ 16 


8. 




86 




86 




0 


9- 


92 




94 






— 2 


10. 




96 


96 






0 


II. 


90 




92 






— 2 


12. 


90 




90 






0 


13- 


86 








86 


0 


14. 




100 


82 






+ 18 


15. 




100 


78 






+ 22 



More important and interesting observations were 
made simultaneously on the arm and the finger of 
the opposite member, the modified finger-cuff being 
employed. 

Comparative blood-pressure measurements on the left 
upper arm and the right middle finger. Patient sit- 
ting; warm day; maximal pressure in mm. Hg. 



Arm 92 92 94 

Finger 82 82 86 

Arm 90 94 88 

Finger 88 84 86 

Arm 94 96 90 

Finger . . 90 84 



ON THE BLOOD-PRESSURE IN SURGERY. 



It is seen, therefore, that but a small difference was 
found between these two methods, but the pressure 
in the arteries of the fingers is generally lower than 
that of the brachial. It was noted that in a series of 
successive determinations small values were first ob- 
tained, which rapidly increased, then remained con- 
stant. The compression in itself seems, therefore, to 
be a blood-pressure-raising measure. Recklinghausen 
concludes that the accuracy of the Gaertner tonome- 
ter is but small, and the values obtained thereby are 
too low. A low limit of the maximal pressure can, 
however, be assumed to be obtained thereby. 
Fraenkel also takes exception to the Gaertner to- 
nometer, in that it alone records the maximum press- 
ure without an indication as to the mean pressure 
being necessarily obtained therefrom. In aortic in- 
sufficiency, however, a high maximum pressure exists 
as well as a low minimum pressure without the mean 
pressure varying much from the normal. Another 
error which is attached to this method is that the 
pressure is measured on a small peripheral artery. 
Peripheral arteries, however, have a relatively strong 
muscularis, and when, under the influence of psychi- 
cal excitement, the lumen narrows, a lower pressure 
than normal is obtained. Therefore it is not to be 
recommended, as has been suggested, that successive 
measurements be made on the same finger, as the 
vessels after the first attempt are more or less in a 
state of paralytic relaxation. 

Stanton, in criticising the Gaertner tonometer, states 
that the assertion that it registers the mean pressure 
has been denied by a few investigators. " While it 
seems plausible that the flushing of the skin cannot 
occur until the external pressure is below that within 
the artery, it is likely that the apices of the pulse- 
waves will break through and cause the flush at a 
higher level than the mean pressure." In his own 



ON THE BLOOD-PRESSURE IN SURGERY. 327 

observations it is stated it was difficult to define ex- 
actly the point of flushing, and in many instances 
this occurred gradually, and the pressure at which 
the flush appeared seemed to be dependent on the 
degree at the primary pressure — a high pressure 
giving a lower flushing point. Gushing states that 
the exact level at which the flushing occurred was 
also hard to determine in negroes and in all cases 
in which artificial light was used. In many instances 
it -was practically impossible, according to Stanton, 
to get two successive readings to correspond with 
each other, and frequently a variation of 20 mm. or 
more between the high and low points was found in 
a series of ten successive tests on the same patient. 

Upon the Results obtained by Various Methods. 

The normal blood-pressure, as ascertained by the 
various methods, shows a variation which is more or 
less constant. With the v. Basch method v. Basch 
himself states the normal pressure to be 100 to 
130, with 150 still within the limits of the normal. 
In a later publication he, however, states that the 
normal pressure varies between 135 to 165 mm. Hg., 
but says that a pressure above, or below, this point 
is not necessarily pathological. Zadeck, as well as 
Christeller, determined the normal value as meas- 
ured in the radial artery to be from 70 to 150 mm. 
Hg., although in the majority of cases this variation 
was much more limited, — viz., 100 to 130 mm. An 
increase or decrease from this figure is by Chris- 
teller regarded as pathological. 
V. Ziemssen gives a somewhat lower value, 80 to 
no mm. Hg. He states that he had repeatedly ob- 
served the blood-pressure in man by both the ma- 
nometer and the v. Basch method simultaneously on 
the temporal arteries of both sides and found that 
there was but a very slight difference between the 
two. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Fedener gives as the normal value 70 to 90 to 100 
mm. Hg., while Eckert in healthy females, twenty 
to thirty years of age, obtained a median pressure of 
174 mm. 

Potain, with his method, gives as the normal, 15 to 
19 cm. for males, and 14 to 18 cm. for females, of 
from twenty to twenty-five years of age. In younger 



individuals he obtained : 

Five to seven years 8 cm. 

Eight to twelve years 9 cm. 

Thirteen to sixteen years 13 cm. 

Eighteen to twenty years 15 cm. 



After this the blood-pressure is stated to increase 
progressively with age, it being said to register 20 
to 24 cm. in old age, this being, however, in part 
due to a sclerosis of the arterial walls. 
Investigations as to the pressure with the Riva Rocci 
method are more numerous. Gumprecht gives as the 
general average : 

Ghildren 90 to no mm. Hg. 

Females 120 mm. Hg. 

Males 140 mm. Hg. 

Sahli, according to Huber, obtained a general average 
which was still higher, 150 to 160, while Boeri as- 
serts that the physiological pressure, as obtained by 
this method, oscillated between 120 and 140, it being 
considered low when below no to 100, and high 
when above 160 to 170. Hochhaus, on the other 
hand, states that the normal pressure may oscil- 
late between 100 and 160 mm. Hg., and Tigerstedt, as 
stated by Masing, gives the limits of healthy adults 
as 100 to 210 mm. Hg., and, as stated by Jellinek, 
gives a mean of 150 mm. Hg. 

Hensen, in twenty-five healthy laborers from seven- 
teen to thirty years of age, found the blood-pressure, 
as measured by the Riva Rocci method, to vary be- 
tween 105 to 158 mm., or a mean average of 137. 



ON THE BLOOD-PRESSURE IN SURGERY. 



In thirty healthy females of the same age it varied 
between 105 and 160, or a mean average of 132 mm. 
He states that 100 to 160 is therefore to be consid- 
ered as the normal value, with 100 to no, and 150 
to 160 as the limits, outside of the pathological. 
Mueller obtained almost similar values, — viz., 140 
to 150 mm. Hg. He, however, holds that these are 
too high, as with the v. Recklinghausen modifica- 
tion cuff the normal registered but 105 to 115. 
The difference in the results obtained by these two 
methods is shown by Recklinghausen in a compara- 
tive table. The blood-pressure was measured simul- 
taneously on both arms, the regulation Riva Rocci 
cuff, 5 cm. wide, being attached to the arm and a 
cuff 12 cm. broad to the other. 



Pulse returns . . 
Pulse returns . . 
Pulse disappears 
Pulse returns . . 
Pulse returns . . 
Pulse returns . . 
Pulse disappears 



Broad Cuff. 
Right arm ... 90 to 96 
Right arm ... 92 to 100 
Right arm ... 90 to 98 
Right arm .. 92 to 98 
Left arm .... 96 to 104 
Left arm .... 94 to 104 
Left arm .... 104 to 108 
Average .... 94 to loi 



Riva Rocci Cuff. 
Left arm ... 116 
Left arm . . .114 
Left arm . . . .112 
Left arm .... 1 14 
Right arm . 118 
Right arm . . . 120 
Right arm . . . 120 
n6 



More lately Masing has estimated the median blood- 
pressure as determined by the Riva Rocci method in 
young children to be 135 to 140 mm. Hg. 
With the Gaertner tonometer lower values have been 
obtained. 

Gaertner himself estimated the normal pressure to be 
from 90 to 105. Weiss subsequently stated it to be 
90 to 120 in males, and 80 to 100 in females. 
Schule gives it as 80 to 130; in half the cases it, 
however, registered from 100 to no, so that he 
rather assumes the latter to be the normal for adults 
in the sitting posture. Heim, for children, obtained 
a normal value of from 80 to 90, the extremes being 
75 to 95. Sommerfeldt states the normal pressure 
to be 100 to 130 mm. Hg., and Grebner states the 



330 



ON THE BLOOD-PRESSURE IN SURGERY. 



normal pressure to be lOO to 120 to 135 mm. Hg., 
as determined in persons from eighteen to thirty-five 
years of age. 

Jelhnek, in an extensive series of observations, ar- 
rives at the conclusion that it is difficult even under 
physiological conditions to obtain a normal value, 
as great differences in this respect are to be found. 
In the great majority of cases, the measurements 
having been conducted on five hundred soldiers, the 
normal pressure was found to vary between 100 and 
160, but figures above and below this were also found 
in normal persons. 

Strauss, in his investigations on healthy males, all 
below thirty-six years of age, obtained a normal value 
of 90 to 100 mm. Hg., it being nearer to 90 than 
to 100. 

Oliver in his method estimates the average arterial 
pressure to be 100 mm. Hg. as taken at the radial 
artery, with the body in the recumbent position. To 
this average he, however, states that a margin of 10 
mm. above or below must be added. This margin 
embraces in the majority of healthy subjects the 
average physiological variations. 
The blood-pressure in the normal condition, as has 
been determined by the various moods, shows phys- 
iological variations. Most observers have noted a 
higher pressure in males than in females, and the 
latter a higher pressure than in children. In boys he 
found that the pressure was higher than in girls of 
the corresponding age. 

Oliver says that the arterial pressure is much the 
same in women as in men, and Hensen states that 
the difference between the young and adults is not 
very evident, it being found by him that children 
five to six years old may have the same pressure as 
adults. With increase of weight and height the 
blood-pressure increases; with increasing age simi- 
lar observations have also been made. 



ON THE BLOOD-PRESSURE IN SURGERY. 



A symmetrical inequality as to the pressure of the 
two sides of the body has also been noted by a few 
observers. Eckert with the v. Basch instrument 
found that the pressure of the left temporal artery 
was higher than that of the right, explaining this 
fact from the direct origin of the left carotid from the 
arcvis aortse. As stated in his table : 



Age. 


Body length. 


Medium blood-pressure. 




Cm. 


Right temporal. 


Left temporal 


2 to years . . 


■ • 74 


to 81 


95 


99-5 




80 


to 86 


96 


100 


4 to 4>^ years . . 


. . 81 


to 89 


97-5 


102 


5 years 


• ■ 79 


to 105 


103 


105 


6 to 6%, years . . 


99 


to lOI 


107 


109 




■ • 105 


to 107 


109 


III. 5 






to 116 


108 


115 






to 116 


II5-5 


II7-5 


10 to II years . .' 


. . 119 


to 130 


113 


116.5 


12 to 13 years . . 


. . 124.5 to 133 


112 


114 



Jellineck in this connection found that out of twenty 
soldiers the values obtained on the right and left 
hands were almost identical. In forty-nine cases, 
however, the tonometer registered higher on the right 
than on the left hand. This was verified by repeated 
observations. In eleven cases the vakte on the left 
hand was 5 cm. higher than on the right. 
Diurnal variations of the blood-pressure have been 
frequently observed. Zadeck found that with the 
v. Basch instrument the blood-pressure varied dur- 
ing the course of the day similarly as occurs with 
the excretion of urea and CO2O. Although in most 
cases the pressure was found to fall in the after- 
noon, at times it woitld rise from 8 to 15 mm., and 
occasionally higher, this rise being independent of 
the noon meal. 

In the observations of Oliver as to the diurnal rise 
in the blood-pressure — both arterial and venous— 
throughout the day, the venous pressure Avas found 
to be both absolutely and relatively lower than the 



ON THE BLOOD-PRESSURE IN SURGERY. 

mean arterial pressure in the morning and in the 
earHer half of the day than in the subsequent hours 
and in the evening. The arterial pressure and espe- 
cially the maximum arterial pressure increased as 
the day advanced and attained its highest point in 
the evening. Hensen found that these daily varia- 
tions, which frequently registered lo to 20 mm. and 
even 40 to 60 mm., and which under normal con- 
ditions could reach 25 mm. within an hour, were 
neither constant nor did they occur with regularity. 
The blood-pressure might be higher in the morning 
or inversely in the evening. 

After the ingestion of food, decrease in the blood- 
pressure has frequently been observed. Colombo, as 
cited by Recklinghausen, found with the method of 
Mosso that the blood-pressure was highest prior to 
the main meal and lowest a few hours after, — i.e., 
at the height of digestion. 

Zadeck, however, noted an increase of from 10 to 
20 mm. Hg., which is attributed to the increase of 
the blood volume from the greater diffusion into the 
splanchnic veins during the process of digestion. 
Oliver states of the digestion that it would seem that 
the mere intake of solids or liquids produces at once 
a rise in the arterial pressure, mean and maximum, as 
well as in the venous pressure. He observed that in 
the morning before breakfast the mere taking of 
a glass of cold water could within five minutes 
raise the arterial pressure 5 mm. or more, and this 
effect could continue for ten or fifteen minutes. The 
mere ingestion of anything, it is said, appeared to 
stimulate the circulation immediately in a reflex 
manner. This view is supported by the observation 
that when the water was rendered more stimulating 
to the gastric mucous membrane containing a charge 
of carbonic gas or of salt, the rise in the arterial and 
venous pressure was further increased. 



ON THE BLOOD-PRESSURE IN SURGERY. 



The digestive process affected the blood-pressure con- 
siderably. The maximum arterial pressure was usu- 
ally raised throughout the digestion of each meal. As 
a rule, the mean arterial pressure was likewise in- 
creased while the venous pressure fell. The rise of 
the mean arterial and the fall of the venous pressure 
were not invariable, they being, as a rule, observed 
after the ordinary solid meals. However, after a 
meal, like that of breakfast, containing a prepon- 
derance of warm fluids, the mean arterial pressure 
much more commonly fell than the venous pressure 
rose. In this way, it is stated, breakfast tends to 
lower the mean arterial pressure, even though it raises 
the maximum arterial pressure. 
Jellineck, in a tabulation of twenty cases as to the 
influence of the digestive process on the blood-press- 
ure, reports the following: 



No. 


Age. 


Before meals. 


.After meals. 


Pressure mm. 


Pulse. 


Pressure mm. 


Pulse. 






no 


70 


140 


78 


2 . . . 


. ... 21 


140 


72 


160 


84 


3 ■ • • 


. ... 20 


140 


74 


150 


84 


4 . . . 


. ... 22 


no 


68 


120 


76 


5 ■ • • 


. ... 23 


120 


70 


140 


86 


6 . . . , 


. ... 23 


no 


68 


140 


84 






90 


60 


150 


90 






150 


70 


130 


70 


9 . . . , 




130 


70 


130 


86 






130 


72 


130 


88 






120 


64 


140 


86 






120 


60 


140 


80 


13 ... , 


. ... 22 


no 


58 


140 


84 


14 . . . 




150 


64 


120 


90 


15 . . . 


. . 23 


100 


60 


140 


98 


16 . . . 




120 


64 


140 


78 


17 . . . 




120 


66 


140 


78 


18 . . . 




100 


68 


140 


78 


19 . . . 




no 


70 


no 


78 


20 ... , 


. ... 22 


140 


72 


140 


86 



Thus, out of twenty cases, an increase in the pressure 
was noted in fourteen, while in four the pressure 



334 



ON THE BLOOD-PRESSURE IN SURGERY. 



did not vary, and in two it fell. Furthermore, in 
forty-two cases, in which the pressure was measured 
six times daily for ten successive days, the highest 
values were nearly always obtained during digestion. 
Recklinghausen, in accordance with other observers, 
also reports that the pressure is liable to variations 
during the process of digestion. In his observations 
he found that immediately after the mid-day meal the 
pressure rose. 

Hensen, in contradiction to these, found that the 
pressure during digestion did not rise according to 
a definite rule. Simultaneous observations on a num- 
ber of individuals, the same diet having been given, 
showed that while in one the pressure regularly rose 
fifteen to twenty-five minutes after the meal, in an- 
other individual this did not occur. 
According to Weiss, the pressure, as measured with 
the tonometer, falls after digestion. (See Fig. 63.) 



"S 


S" 






17" 


12 30 




7* 


J** 


5 JO 




9* 


■10 x 
































JI3Q 










^ / 


















120 






1 








— ^ 
i ^ 
\ 




/ ^ 






F 






V 




T 








Vs 










— 




-too 






















I 






90 
















<5 








■1 



Fig. 63. — Chart I. (Weiss). — Physiological variations in the blood -pressure. 

Schule, however, states that the decrease of pressure 
from the ingestion of food, as is asserted to occur by 
Weiss, could not be found. The alterations in the 
pressure were even absent in a case of dyspepsia. He 
concludes that a relation between the ingestion of food 
and the blood-pressure does not exist. Ingestion of 
fluids was furthermore found by this same observer 
not to influence the blood-pressure in a definite way. 
In a person whose pressure was 105 cm. it fell to 
90 mm. ten minutes after the ingestion of 1000 cm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



water, and ten minutes later it registered lOO mm. 
The ingestion of fluids with regard to its influ- 
ence on the blood-pressure has, however, been more 
especially studied by Maxinowitsch and Rieder with 
the V. Basch instrument. They report that all fluids 
increase both the pulse frequency and the pressure 
notably according to the quality of the liquid. Beer 
gave the most marked variation, probably owing to 
the CO2 and the alcohol contained ; then followed in 
their successive order wine, coffee, tea, cocoa, and 
water. 

Oliver, in this connection, also reports some prelimi- 
nary observations on the effect of alcohol, coffee, and 
tea. It was found that these do not all exert the 
same influence on the different parts of the circu- 
latory organs. Alcohol and coffee seemed more par- 
ticularly to stimulate the ventricle, while tea appeared 
mainly as a vasomotor stimulant. 
The former raised the maximum arterial pressure, 
as also the venous pressure, while tea augmented the 
mean arterial pressure, lowered the venous pressure, 
and did not materially affect the maximum pressure. 
Exercise. — Mosso, according to Brunton and Tunicliffe, is 
stated to have found that an arm, enclosed in a 
water plethysmograph, diminished in volume during 
the contraction of the flexors and increased above 
its normal volume immediately after the cessation of 
the contraction. (See Fig. 64.) Also that an in- 
crease in the amplitude of the pulsation of the whole 
arm took place, both during and after the contraction 
of the flexors. Tshcelinoff observed, with the ma- 
nometer of Mosso and v. Basch, that the pressure rose 
in almost all instances after ascending the stairs ; this 
rise, however, registered less with the instrument of 
Mosso than with that of v. Basch. Oertle also 
observed a considerable rise in the general pressure 
following muscular exercise. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Zadeck similarly found that muscular exercise in- 
creases the pressure which he assumed to be due to 
the increase in the cardiac action. This rise, which 
disappeared soon after rest had again been instituted, 



1 


1 
£ 


o o2 
£ * a~ 


b 5 


AFTER 

Moveiheht\ 






o 


u 

k 




* 

o 


U) 

tr 


+ 


o 
o 


o> 
6 
o> 


O 




95° 


••• 




















30° 




















Blood Pressure ____ 
Respirators freq 


Of 












\ 

* 








co° 




/ 












• ••• 


• • 




75° 






















70* 






















65° 






















20° 










































15" 























Fig. 64. — Chart II. (Brunton and Tunicliffe). — Effects of movement on blood- 
pressure. 



registered in moderate exercise 10 to 20 mm., and in 
greater exertions, such as running, 30 mm. Hg. 
Maxinowitsch and Riedner in an extended series of 
observations with the v. Basch instrument found 
that the greatest height in the increase of the blood- 
pressure from work was reached immediately after 
the cessation of work. This rise from the normal 
being 25 to 50 mm. Hg. 

Brunton and Tunicliffe, employing the sphygmoma- 
nometer of Mosso with the patient in the erect pos- 
ture, found that generally the effect of exercise, so 
gentle as to cause no increase in the respirations or 
in the pulse, was, that during the exercise itself the 
pressure first rose above the normal, but began to 
fall again, even during the continuance of the exer- 



ON THE BLOOD-PRESSURE IN SURGERY. 



cise, and continued to fall, so that at the end of the 
exercise it had usually again reached the normal. 
After the cessation of the exercise the pressure con- 
tinued to fall, remaining subnormal for half an hour 
or longer, then gradually rising to its initial height. 
The discrepancy between these observations and that 
of other observers is attributed to the difference in 
the amount of exercise taken. 

In case of other observers the amount of exercise 
taken was sufficient to increase the frequency of the 
pulse and respiration, while in their experiments this 
did not occur. 

Oliver, in general, corroborates the findings of Hill, 
stating, however, that the rise in the pressure from 
the effects of the exercise is not the invariable rule. 
This effect, as stated, is the resultant of two factors, 
central and peripheral, one being the increased ven- 
tricular action, the other the dilatation of the periph- 
eral vessels. In certain instances it was noted that 
the mean pressure remained without appreciable al- 
teration, or actually fell, though there was no suspen- 
sion of fatigue, and, moreover, after a certain amount 
of exercise, this amount apparently being subject to 
individual variation, a stage was reached in which 
the mean arterial pressure declined. It is assumed 
that it is not improbable that the different propor- 
tions of the central and peripheral effects of the ex- 
ercise might induce some variability as regards the 
rise in the mean pressure, or might altogether pre- 
vent the rise, or even determine a fall. 
Edgecomb and Bain, by the method of Oliver, con- 
clude that the effect of the exercise on the blood- 
pressure depends on the severity of the exertion. An 
initial rise was found to occur in all forms of exer- 
cise. If it was mild, a fall occurred during its con- 
tinuance; if severe, the fall was maintained. After 
the cessation of both moderate and severe exercise, 

22 



ON THE BLOOD-PRESSURE IN SURGERY. 



a fall occurred. The venous pressure was found to 
be raised during all forms of exercise, and to remain 
raised during the subsequent arterial fall. The re- 
turn to the normal, after the exercise, occurred 
more or less rapidly, according to the gentleness or 
to the severity of the exercise, and to the temperature 
of the atmosphere. 

Masing, determining the effects of exercise by the 
Riva Rocci method in applying the instrument to 
the person in the horizontal position, and who for 
this purpose exercised the leg, found that in one hun- 
dred and forty attempts of this nature, with six thou- 
sand determinations of the pressure, it rose most 
generally immediately after the beginning of work. 
At times a short decline preceded the rise. The rise 
in the blood-pressure is attributed to the increased 
cardiac action, whereby more blood is thrown into 
the aorta. The increase in the cardiac action consists 
in an acceleration of its beats and in an increase in 
the volume of the beat. In young people the rise 
was found to be independent of the duration of the 
work ; in old people, however, it frequently fell after 
prolonged work. Immediately after the cessation of 
work it declined more or less rapidly to the normal. 
The rise in the pressure was the greater, the greater 
the amount of work performed. The reason that in 
old age the pressure falls earlier is due to the insuffi- 
ciency of the muscular tissues, its contractile sub- 
stance being said to be partially lost. 
Concerning the effects of exercise on the blood-press- 
ure, Recklinghausen reports an observation in which 
the patient was placed in the horizontal position 
and then elevated a 5-kilo weight, with one hand, 
above the level of the chest. A gradual rise of the 
pressure occurred, which in one and one-half minutes 
registered 14 cm. Immediately after the exercise 
was discontinued the pressure fell 7 cm. 



ON THE BLOOD-PRESSURE IN SURGERY. 



More lately, Schule, in his investigations with the to- 
nometer, denies that physical exertions influence the 
pressure, while Weiss asserts that a rise occurs, as 
does Grebner, while Gaertner states that a fall is usu- 
ally to be noticed. 

Potain gives the influence of the exercise on the 
blood-pressure as variable. 

In general, all moderate exercise elevates the arterial 
pressure, this effect being produced at the moment 
activity is begun. All prolonged and energetic or 
severe exercise, on the other hand, is said to lower 
the pressure. 

Rest. — ^Zadeck, estimating the pressure of persons at rest, de- 
termined it to be lowered. In a comparative inves- 
tigation after awaking and immediately after rising 
he found with the Basch method : 



In bed. After rising. 

A. August 7 60 to 70 (80) 72 to 74 (92). 

August 8 72 to 76 (76) 76 to 82 (76). 

August 12 76 to 80(76) Soto 84(96). 

B. 126 to 130 (73) 140 to 146 (84). 

C. 94 to 100 (72) 98 to 104 (76). 



As stated by C'iver, rest, mental as well as physical, 
has a marked influence on lowering the pressure (ar- 
terial as well as venous), this being manifestly due to 
a reduction in the force and in the frequency of the 
heart's action. Maximum and mean arterial pressure 
are both lowered in proportion to the reduction in 
the cardiac action, the former, however, to a greater 
degree. The fall in the venous pressure is still more 
pronounced than in those of the arterial, as the 
peripheral vessels probably shrink from the diminu- 
tion of the distensile pressure of the ventricles. 
Hill, in observations with the sphygmometer in sleep, 
found that the pressure falls very decidedly. This 
fall in the pressure is attributed directly to the warmth 
and rest in the horizontal posture, with which sleep 



ON THE BLOOD-PRESSURE IN SURGERY. 



is associated, as when lying awake in the morning 
the fall of pressure was as great as when sleepy at 
night, that is, as long as the subject remained quiet 
and in the recumbent position, and even in the sitting 
position such a fall would occur, given the conditions 
of warmth and rest. 

Wagner also found that the pressure fell in sleep. 
Psychical Influences. — Gumprecht asserts that all psychical in- 
fluences, either of a joyful or sorrowful nature, mark- 
edly influence the blood-pressure. After anger it 
may rise 30 to 40 mm. One patient, whose pressure 
was measured daily and almost constantly, registered 
170; after a game of cards it was found to be 202 
mm. A moderate amount of laughing caused a 
pressure to rise from 156 to 172. A man, after 
receiving a traumatism, showed a blood-pressure 
value of 143, and, after he had related the story of 
his affliction, 172 mm. Recklinghausen reports an 
observation on his own person concerning the psychi- 
cal influence on the blood-pressure. As measured on 
the finger, he noted in one instance a rise of 12 cm. 
of water in the blood-pressure at the moment when 
some one entered the room to whom he intended to 
make an explanation. Oliver, speaking of mental 
exercise and emotional excitement, states that the 
blood-pressure may be almost as powerfully affected 
by the activity of the nerve-centres as by mviscular 
exercise. It is most particularly raised by any form 
of emotional excitement. 

Hill, to indicate the result of mental excitement on 
the general blood-pressure, reports the following 
table : 

EXAMPLE III. 

„. J-.- Position of Arterial Pulse- 

Time. Conditiou. b^jy pressure. rale. 

1.30 P.M. Before lunch ; quiet. Sitting. 103 to 105 64 
4.30 P.M. Engaged in discus- 
sion and excited. Sitting. 130 to 140 84 



ON THE BLOOD-PRESSURE IN SURGERY. 



EXAMPLE IV. 

Time. Condition. ^°body.°* 
1.30 P.M. Before lunch ; quiet. Sitting. 
4.35 P.M. Quiet after mild ex- 
ercise. Sitting. 



Arterial 
pressure. 

103 to 105 

103 



Pulse- 
rate. 

64 



74 



Time. 
II A.M. 
II. ID A.M. 



11.20 A.M. 
11.30 A.M. 
12.30 P.M. 



EXAMPLE VII. 

(To illustrate result of muscular activity. ) 

Condition. 



Position of 
body. 

Sitting. 



Arterial 
pressure. 



Reading ; quiet. 
After running four 
hundred yards 

fast ; panting. Sitting. 120 to 130 

Resting. Sitting. no to 115 

Resting. Sitting. 100 to 103 

Resting. Sitting. 90 to 95 



Pulse- 
rate. 

64 



100 

100 
96 
80 



Schule states that strong psychical excitement pre- 
disposes strongly to high-blood value in cases where 
the patients are not anemic or marasmic. Pain, he 
states, seems to lower the blood-pressure. In four 
cases of sciatica the pressure was observed to meas- 
ure 70, 80, 90, and 100. 

Strauss, speaking of psychical influences, states that 
high values were obtained in patients who had been 
in the clinic a short time, while in those who had re- 
mained for a longer period a lower value was found. 
Successive determinations of a relatively high tono- 
metric value in persons in which arteriosclerosis, 
nephritis, or chronic lead intoxication can be ex- 
cluded arouse a suspicion of a neurosis. Pain, he 
states, increases pressure. In four cases of trauma 
a rise of 20, 30, 35, and 40 was noted upon pressure 
upon a nerve. Even in healthy persons pinching of 
the integument was noted to increase the pressure. 
In twenty-five such observations the rise and press- 
ure was absent but three times. In fourteen cases 
this rise registered over 15 mm., and in four cases 
20 mm. Hg. 



342 



ON THE BLOOD-PRESSURE IN SURGERY. 



Hein, in his investigations with the Gaertner's tonom- 
eter concerning the psychical influence, observed that 
the first measurement was always lo to 20 mm. 
higher than the succeeding ones measured a quarter 
of an hour afterwards. 

In neuropathic children a higher value was constantly 
obtained, this being due to the momentary psychical 
excitement. In twenty-five observations on neuro- 
pathic children, such as those having headache, 
" stitch in the side," loss of appetite, vomiting, faint- 
ing, dizziness, convulsions, etc., a distinct rise in the 
pressure was noted. As illustrative of the degree to 
which psychical effects may influence the pressure, 
the cases of two boys are cited, one of whom, twelve 
years old, had pharyngitis, and the other, eleven and 
one-half years old, slight bronchitis. In both, the 
pressure, measured several times, registered 95 and 
80 mm. Both boys had toothache, and before the 
teeth were extracted one had a pressure of 160 mm., 
the other, of 140 mm. A few days later the normal 
value was again obtained. The fear of the extrac- 
tion of the teeth had raised the pressure in both of 
these cases. 

Kapsammer, speaking on the subject, states that psy- 
chical conditions of the patient determines marked 
oscillations of the blood-pressure, so that the real 
pressure is not easily obtained. These oscillations 
are dependent upon the intelligence, temperament, 
and health of the patient. They become marked in 
nervous and hysterical persons, and, on the other 
hand, are much less or altogether absent in phleg- 
matic persons or in persons unconscious. 

Fever. 

In certain pathological conditions a marked variance 
in the blood-pressure has been noted, and especially 
so in fevers. Zadeck reported the blood-pressure in 



ON THE BLOOD-PRESSURE IN SURGERY. 



the various forms of fever, such as recurrent and in- 
termittent fever, typhoid, and pneumonia. He found 
that in all cases of typhoid the rise in the blood- 
pressure almost constantly coincided with the height 
of the temperature, this being true also of the con- 
tinued as well as of the remittent fevers. In pneu- 
monia, the temperature, pulse frequency, and blood- 
pressure fell simultaneously in one case, the fall of 
the temperature, 4°, occurring with the diminution 
of the pulse, of from 30 to 50 beats, and a fall of the 
pressure, of from 30 to 40 mm. In another case the 
fall of 2° corresponds with a diminution of 22 in 
the pulse, and a fall in the pressure of 20 mm. He 
concluded that fever in general causes an increased 
blood-pressure, this being due to the increase in the 
temperature of the blood, as when baths are given in 
fever the pressure was again lowered. Exception, 
however, is made to such fevers as are caused by 
septicemia, pyemia, etc., which experimentally on 
dogs were found to lower the pressure. 
V. Basch, from an extended number of observations, 
in the various diseases with fevers, states that the 
question where the pressure rises or falls in fevers 
cannot be answered by a simple yes or no, as various 
other factors which influence the blood-vessels are 
to be given consideration. 

Wetzel, in a series of twenty observations on fevers, 
including typhoid, diphtheria, pneumonia, and acute 
gastritis, in which the pressure was measured by 
the method of v. Basch, concludes that increased 
temperature tends to lower the blood-pressure. It 
was noted thai in all cases the rise in the temperature 
was concomitant with the fall of the pressure, and 
that with the return of the temperature to the normal 
the pressure again rose. 

Arnheim, on the other hand, essentially agrees with 
the result which Zadeck obtained. In typhus the rise 



1 



ON THE BLOOD-PRESSURE IN SURGERY. 



in the pressure was almost always determined, — the 
increase being parallel to the height of the axillary 
temperature, the pressure being exceptionally high in 
the fastigium and gradually falling during the defer- 
vescence. In recurrent fevers, a marked rise in the 
pressure also occurred during the paroxysm of fever. 
In the apyrexia the blood-pressure also fell, but not 
as markedly as the axillary temperature, and re- 
turned soon to the normal. 

Eckert, from 28 observations on the various forms 
of fevers, concludes : 

( 1 ) That fever always more or less increases the 
pressure. 

(2) That in fever of short duration the rapid rise in 
the temperature and a distinct crisis affect the press- 
ure notably in that it distinctly rises with the rise 
of the temperature and during the crisis it falls below 
the normal. 

(3) Continued fevers also at first cause a rise in 
the pressure, but if the fever continues for a longer 
period, a distinct fall in the pressure follows. 
Hensen, discoursing on the conflicting views as to 
the rise or fall of pressure as found by the various 
observers in the termination of fevers, states that 
these differences are dependent on the inability to 
distinguish the exact condition present at the time of 
the determination. The normal variation which oc- 
curs spontaneously during health are complicated 
with the pathological conditions. Furthermore, the 
fever is complicated with numerous other disturb- 
ances, which, in themselves, influence the pressure. 
Finally, the normal pressure has been but rarely de- 
termined before the onset of the disease. In his own 
observations he noted that with the increase of the 
fever, a moderate rise of blood-pressure from 10 to 
30 mm. frequently occurred. In fevers of longer 
duration a gradual fall in the pressure is stated to 
have occurred. 



ON THE BLOOD-PRESSURE IN SURGERY. 



Schule states that in his observation, in accordance 
with the general acceptance, the pressure fell in fever. 
It fell at times to 80 and even 50 and 60 mm. In 
individual cases the pressure rose vi^ith the decrease 
in the fever. The cessation of the pathological 
process, as in pneumonia, etc., may also have played a 
part. 

Potain states that typhoid fever lowers the arterial 
pressure. In general this fall is from 3 to 4 and 
5 cm. This fall is stated to be neither proportionate 
to that of the temperature nor to the frequency of 
the pulse. In the defervescence the pressure at times 
falls suddenly, then during the convalescence gradu- 
ally rises again to the normal. In pneumonia and 
pleurisy the blood-pressure is also stated to be lower, 
this fall being, however, not as great. 

Cardiac Disease. 



The blood-pressure in the various cardiac diseases 
has been noted by several observers. V. Basch re- 
ports the following: 



No. 


Sex. 


Age. 


Pressure. 


Remarks. 


I . 


. M. 


28 


120 


Insufficiency in mitral stenosis. 


2 . 


. M. 


50 


"5 


Insufficiency in mitral stenosis. 


3 • • 


. M. 


20 


116 


Insufficiency in mitral stenosis. 


4. . 


. M. 


40 


122 


Mitral stenosis. 


5 • 


. F. 


30 


100 


Insufficiency and mitral stenosis. 
Hydrops ascites. 


6 . 


. F. 


22 


150 


Insufficiency and mitral stenosis. 
Recent endocarditis. Acute 
rheumatism. 


7 • 


. M. 


53 


195 


Aortic insufficiency. 


8 . 


. M. 


52 


140 to i8c 


Aortic insufficiency, with aneu- 



rism of the aorta. 



Hensen denies the assertions of v. Basch that the 
blood-pressure in mitral disease is lowered, stating 
that in general the pressure does not vary from the 
normal. In a tabulation, including the various forms 
of cardiac disease, he reports : 



346 



ON THE BLOOD-PRESSURE IN SURGERY. 



I. MITRAL INSUFFICIEN'CY. 

MALES. 

No. Age. Pulse. Pressure. Remarks. 

1 . . i6 70 120 Old mitral insufficiency after 

arthritic rheumatism. 

2 . • 24 76 i5o to 170 Mitral insufficiency after ar- 

thritic rheumatism, three 
months. 

3 . . 25 68 143 Recent mitral insufficiency 

and polyarticular rheuma- 
tism. 

4 . . 21 So to 100 120 to 125 Mitral insufficiencj' for three 

years. Slight incompen- 
sation. 

5 . . 22 64 to 92 130 to 135 

6 . . 22 72 147 Recent mitral insufficiency 

and pol\-articular rheuma- 
tism. 

7 . . 31 76 150 For ten years slight mitral 

insufficiency. Acute dila- 
tation of heart. 

FEMALES. 

No. Age. Pulse. Pressure. Remarks. 

8 . . 21 80 to ICO 130 to 145 Old mitral insufficiency. 

9 . . 15 70 to 120 no to 140 Mitral insufficiency, one to 

two years' standing. 

10 . .50 125 Old mitral insufficiency. 

11 . . 30 So to 100 125 to i5o Mitral insufficiency, one to 

two years old. 

12 . . 24 So to 100 120 to 125 Slight mitral insufficiency. 

CHILDREN. 

No. Age. Pulse. Pressure. Remarks. 

13 . .15 88 to 112 So to 113 Uncompensated mitral insuf- 

ficiency. 

14 . .11 100 123 Mitral insufficiency, four 

years' standing. 

15. .10 92 133 iSIitral insufficiency, one-half 

year's standing after 
chorea. 

II. — MITRAL STENOSIS. 

No. Age. Pulse. Pressure. Remarks. 

16 . . 30 80 to 100 105 to 140 Mitral stenosis, ten years. 

17 . . 60 140 Old mitral stenosis. 

iS . . 16 120 127 Old mitral stenosis. Post- 

diphtheritic paralysis. 
19 . .72 140 Old mitral stenosis. 



ON THE BLOOD-PRESSURE IN SURGERY. 



III. — MITRAL INSUFFICIENCY AND STENOSIS. 
MALES. 

No. Age. Pulse. Pressure. Remarks. 

20 . .40 90 to 120 Old mitral stenosis and in- 

sufficiency. 

21 . .21 116 105 to 142 Autopsy. Severe mitral in- 

sufficiency. Uncompen- 
sated tricuspid insuffi- 
ciency. 

22 . . 19 120 130 Mitral insufficiency and ste- 

nosis. Recentendocarditis. 



FEMALES. 

No. Age. Pulse. Pressure. Remarks. 

23 . . 60 150 Old mitral insufficiency and 

stenosis. 

24 . . 38 128 117 Mitral insufficiency and ste- 

nosis. Bronchitis. 

25 . . 17 88 160 Mitral insufficiency and ste- 

nosis, one to two years 
after articular rheumatism, 
with endocarditis. 

26 . .14 88 129 Mitral insufficiency and ste- 

nosis after chorea. 



In compensated mitral disease, Hansen concludes the 
pressure does not vary from the normal in recent 
cases; however, it seems that the pressure is some- 
vi^hat higher. 

Hochhaus, in examining thirty-six cases of cardiac 
neurosis, twenty males and sixteen females, found 
that in males the lowest pressure was 150 mm. Hg., 
the highest being 210 mm. Hg., it usually oscillating 
between 160 and 190. In females the lowest was 
140 and the highest 210, generally oscillating be- 
tween 1 50 and 1 70. 

Weiss states that in cardiac diseases the pressure 
markedly varies so that the relation of the blood- 
pressure to the cardiac disease is of no diagnostic 
value. In individual cases, however, he states it may 
be of some value. The value of drugs in the various 



348 ON THE BLOOD-PRESSURE IN SURGERY. 



forms of cardiac diseases was demonstrated by this 
observer. Among some of his observations are the 
following: Female aged twenty-three; weak and 
very anemic; pulse scarcely palpable; very marked 
dyspnea ; cyanosis ; respiration, 72 ; pulse, 240 per 
minute. Traces of albumin in the urine; dilatation 
of the heart. Anemic murmurs; arteries soft, 
straight, and not well filled. Administration of 
digitalis infusion for three days ; delirium cordis. 
After three injections of camphor oil, the blood- 
pressure was as follows : 

August 17, 9.45 A.M., 90 mm. 

At 9.50, 100 mm. 

At 9.55, 105 mm. 

At 10.00, 105 mm. 

At 10.10, 1 10 mm. 

At 10.20, 105 mm. 

Teaspoonful of digitalis administered every half- 
hour. 

At 12.30 P.M., blood-pressure, 85 mm. 

Four teaspoonfuls of digitalis administered. 
At 5.00 P.M., blood-pressure, 95 mm. 

Nine tablespoonfuls of digitalis administered. 
August 18, 9.00 A.M., blood-pressure, 85 mm.; pulse, 198; 

respiration, 48. 

At 5.00 P.M., blood-pressure, 104 mm.; pulse, 104; respiration, 
36. 

Digitalis continued. 
August 19, 9.00 A.M., blood-pressure, 105 mm.; pulse, 66; 
respiration, 34. 

At 5.00 P.M., blood-pressure, no mm.; pulse, 72; respiration, 
36. 

August 20, 9 A.M., blood-pressure, 50 mm.; pulse, 62; respira- 
tion, 32. 

Digitalis continued. 

Schule remarks that in his determinations, in cardiac 
affections, no positive results could be obtained. 



ON THE BLOOD-PRESSURE IN SURGERY. 34c) 

Compensated cardiac disease, such as mitral stenosis 
and aortic insufficiency were found to have no influ- 
ence on the blood-pressure. Potain gives a pressure 
in many of the cardiac diseases as lower than that of 
the normal individual of the same age and sex. This 
is, however, stated to be very variable, the pressure 
oscillating from 10 to 20 mm. Lower figures, as 
stated, indicate an insufficient compensation and 
render the prognosis unfavorable. It is to be recol- 
lected, however, that grave cardiac affections may 
have an accentuated arterial tension as a concomi- 
tant. Aortic insufihciency of all cardiac diseases lower 
the pressure the least. 

Diseases of the kidney as stated by Hensen give a 
valuable determination, chronic interstitial nephritis 
being constantly accompanied by a high pressure as 
shown in the following table : 

CONTRACTED KIDNEY. 



No. 


Age. 


Pulse. 


Pres.sure. 


Remarks. 


I . 


• 54 


70 


245 


Contracted kidney. Marked 
arteriosclerosis. 


2 . 


• 44 


96 


195 


(Secondary.) Contracted 
kidney. Pulse arrhythmic. 


3 • 


• 50 


90 


205 


Contracted kidney. Chronic 
pulmonary phthisis. 


4 • 


• 23 


112 


185 


Older (interstitial) nephritis. 
Exacerbation after diph- 
theria. 


5 • 


• 51 


80 


144 


Autopsy. Contracted kid- 
ney. Synechia of pericar- 
dium. Cardiac hypertro- 
phy. 


6 . 


• 24 


80 




Beginning uremia. Exitus 
two days. Autopsy. — Con- 
tracted kidney. Cardiac 
hypertrophy. 


-7 • 


■ 37 


96 


242 


Contracted kidney. Moder- 
ate arteriosclerosis. Ure- 
mia. 


8 . 


. 60 


92 


200 


Contracted kidney. Moder- 
ate arteriosclerosis. Be- 



ginning arteriosclerosis. 



1 



ON THE BLOOD-PRESSURE IN SURGERY. 



CONTRACTED KIDNEY — Continued. 



"NT,-! 
IN O. 


Age. 


Pulse. 


Pressure. 


Remarks. 


9 • 


r -1 

• bi 




240 


V^L>11LI dClCU KlUIlcy. OCVCIt; 










arteriosclerosis. Old apo- 












lo 


r r 


104 


181; 






















apoplexy. 


II • 


. 68 


72 


250 


Contracted kidney. Arterio- 










sclerosis. Aortic insurti- 










ciency. Old hemiplegia. 


12 • 




80 to 116 


175 to 218 


Autopsy. — Contracted kid- 










ney. Strong arteriosclero- 










sis. Cardiac hypertrophy. 


T 1 


• "0 


112 


195 to 235 


Autopsy same as 12. 


T A 




80 


235 


Autopsy same as 12. Mod- 










erate arteriosclerosis. 


T C 


• 43 


100 


200 to 210 


No arteriosclerosis. 






CHRONIC PARENCHYMATOUS NEPHRITIS. 


No. 


Age 


Pulse. 


Pressure. 


Remarks. 


16 . 


Ad 




135 


Phthisis. 


17 • 


. 04 




160 


Chronic parenchymatous ne- 










phritis. 


10 . 


• 24 




130 to 135 


Chronic parenchymatous ne- 










phritis (large white kid- 










ney). No cardiac hyper- 










trophy. 


19 . 


. 27 


88 


130 


Moderate chronic hemor- 










rhagic nephritis. 


20 , 


. 26 


60 


142 


Acute hemorrhagic nephri- 










tis. 


21 . 


.36 


72 


120 


Chronic parenchymatous ne- 










phritis. Cachexia. 


22 . 


. 30 


72 


"5 


Acute hemorrhagic nephri- 










tis. 


23 . 


. 29 


64 


155 


Chronic parenchymatous ne- 



phritis. Marked edema. 

In reference to the blood-pressure in nephritis, Weiss 
states that the highest tonometric values are obtained 
in this affection. In the chronic nephritis of young 
people, he states that high determination is an im- 
portant indication, as it points to the increased 



ON THE BLOOD-PRESSURE IN SURGERY. 



peripheral resistance and the hypertrophy of the left 
ventricle, and thickening of the arterial walls. In a 
recent nephritis of short duration, on the other hand, 
even subnormal values are found, so that the tono- 
metric values can be used in the different diagnosis, 
as to the form of renal disease. A parenchymatous 
nephritis of short duration has not as yet a high 
pressure, while a chronic one with a secondary symp- 
tom has. 

Arteriosclerosis. 

Hensen in the consideration of arteriosclerosis on the 
blood-pressure divides this affection into the light, 
median, and strong degrees, to which he appends the 
following tables : 

ARTERIOSCLEROSIS OF MEDIAN DEGREE. 



No. Age. 

I 71 

2 63 

3 69 

4 44 

5 52 

6 65 

7 • 53 

8 46 

9 33 

10 38 

II 50 

12 59 

13 52 

14 59 

15 57 



No. Age. 

17 52 

18 57 

19 63 



MALES. 



Pulse. 


Pre 


76 


160 


92 


165 


68 


160 


40 


130 


108 


175 


normal 


220 


76 


190 


60 


158 


68 


170 


normal 


180 


80 


179 


84 


155 


76 


154 


72 


190 


78 


165 



FEMALES. 

Pulse. Pressure. 

116 215 

80 121 to 160 

80 205 



Remarks. 



Arthritis. 



Dilatatio cordis. 



Remarks. 



ON THE BLOOD-PRESSURE IN SURGERY. 



ARTERIOSCLEROSIS OF HIGH DEGREE. 



MALES. 

No. Age. Pulse. Pressure. Remarks. 

1 53 104 210 

2 60 52 172 Arthritis urica. 

Saturnismus. 

3 71 120 185 

4 55 72 180 

5 80 normal 174 

6 70 52 145 Anemia. Emphy- 

sema. 

7 59 88 210 Coronal sclerosis. 

Asthma cardi- 
ale. 

FEMALES. 

No. Age. Pulse. Pressure. Remarks. 

8 80 72 185 ■ 



The general average of these tables as corrected 
record a figure of 157 mm., or about 20 mm. higher 
than the normal. Variations in the pressure in 
arteriosclerosis are, however, great, and are readily 
explained in that various portions of the vascular 
system may be affected. Other factors also play a 
role in this consideration. Sclerosis of the splanchnic 
vascular system, for instance, exhibits a tendency to 
raise the pressure, although the peripheral arteries 
may not be affected. 

Weiss also found that in arteriosclerosis, the pressure 
is high, M^hich he attributes to the increased cardiac 
action from the increased peripheral resistance and 
the rigid vascular walls. In some instances, however, 
a decrease in the pressure was noted, and this is 
accounted for by the weakened cardiac action as 
shown by the injection of camphor. 
The following is illustrative : 

Male, aged sixty-eight. Extreme atheroma, cardiac 
weakness, obstipation, pulmonary emphysema, hem- 
orrhagic infarct. 
August 7, lying down, roo mm. 



ON THE BLOOD-PRESSURE IN SURGERY. 3^3 

August 7, lying down, 50 mm. (cardiac weakness). 

Patient given three camphor injections. 

After ten minutes, 75 mm. ; pulse, 96. 

After fifteen minutes, 82 mm. ; pulse, 106. 

After twenty minutes, 90 mm. ; pulse, 106. 

In another instance, a female fifty-five years; rigid 

arteries, emphysema pulmonum, dilatation of the 

right heart. 

August 14, pressure, 100 mm. 
Later, collapse. Pressure, 80 mm. 
Patient given three camphor injections. 
After eight minutes, pressure, 120 mm. 
After fifteen minutes, pressure, 125 mm. 
Gradually pressure falls to 1 10 mm. 
August 15, collapse. Pressure, 85 mm. 
Three camphor injections. 
After three minutes, pressure, 120 mm. 
After five minutes, pressure, 138 mm. 
After seven minutes, pressui'e, 150 mm. 
After eight minutes, pressure, 155 mm. 
After nine minutes, pressure, 145 mm. 
After ten minutes, pressure, 140 mm. 
After twelve minutes, pressure, 138 mm. 
After fourteen minutes, pressure, 120 mm. 
After sixteen minutes, pressure, 130 mm. 
Schule gives as the main field for tonometric determi- 
nations, arteriosclerosis and nephritis (especially the 
chronic). Both show the rise in the arterial pressure. 
In arteriosclerosis it is the most constant symptom 
and already present at the beginning of the affec- 
tion. (Abnormally frequent increases in the blood- 
pressure may, however, be the primary causation of 
arteriosclerosis). This increase in the pressure may 
be present at the time in which the peripheral arteries 
do not show any evident thickening of the walls. 
Occasionally these remain unaffected for a long time, 
while central vessels, as those of the abdominal vis- 
23 



ON THE BLOOD-PRESSURE IN SURGERY. 



cera, are already markedly affected. In arterio- 
sclerotic subjects examined in whom the superficial 
arteries were plainly thickened and tortuous there 
was regularly found a distinct rise in the pressure 
as 140, 150, 160, and even 200, the latter being the 
highest figure determined. Tonometry is, therefore, 
to be considered a valuable measure in the determina- 
tion of beginning arteriosclerosis. 
Potain also found that arterial atheroma is constantly 
accompanied by an evident hypertension, but it was 
impossible to exactly estimate the proportion as to 
the degree of atheromatous alterations and the de- 
gree of elevation in the arterial pressure. 
Drs. Cook and Briggs, of Johns Hopkins, made a 
valuable contribution to the study of the effects of 
stimulants upon the blood-pressure, particularly in 
medical cases. Dr. Cook's modification of the Riva 
Rocci instrument, in making the manometer in two 
parts, rendering it more easily carried, has added to 
its practicability. 

Surgical Observations concerning the Blood-Pressure. 

The surgical aspects concerning the rise and fall of 
the blood-pressure have been more especially noted 
by Kapsammer in the various operative procedures. 
With the Gaertner tonometer he noted that in the 
course of two laparotomies the pressure fell once from 
120 to 90, and in the other instance from 170 to 
50 mm. In the opening of an enormously distended 
sigmoid with carcinomatous stenosis a fall of from 
155 to 80 occurred in one observation. Aspiration 
of pleuritic fluid in two instances was also accom- 
panied by a fall in the pressure. Similarly in two 
marasmic persons in which large quantities of fluid 
were removed from the abdomen under the local 
anesthesia a distinct fall in the pressure occurred. In 
the one case, a girl thirteen years old with tubercu- 



ON THE BLOOD-PRESSURE IN SURGERY. 355 

lous peritonitis, more than 10 litres of fluid were re- 
moved, in the mean time the pressure falHng from 
120 to 50 mm. 

Five days later the pressure registered 90 mm. 
In the other instance, a cystadenoma of the ovary, 
12 litres of fluid were removed. The pressure fell 
from 85 to 50 mm. The next day it registered 
53 mm. and the woman died. 

The fall in the pressure in the cases just mentioned 
is explained as being probably caused by the sudden 
relaxation of the vascular system of the splanchnic 
area, and therefore by a decrease in the peripheral 
resistance. Similar cases have been reported by 
Gushing. 

In the surgery of the osseous system it was noted 
that the chiselling of the pelvic bone for a fascial 
sarcoma caused a fall in the pressure from 100 to 60 
mm. In the resection of an elbow under local anaes- 
thesia, however, the pressure rose from no to 165 
mm. 

Resection of the trigeminus caused a rise in the press- 
ure from 120 to 160 when the nerve was stretched, 
and in another instance a rise from about 100 to 170 
mm. 

Gushing has reported most original and interesting 
observations along this line. Some of his charts are 
here reproduced. With the Riva Rocci method he 
found that the moment the Gasserian ganglion was 
evulsed a rapid fall of the blood-pressure occurred, 
and when pressure was applied, the blood-pressure 
rose and the pulse-rate fell. (See Fig. 65.) 
In a case of stretching the sciatic nerve a rise in 
the pressure was noted, while in a breast operation, 
in which no important sensory nerve-trunks were 
handled or divided, no appreciable effect on the 
pressure was observed. In amputations in which the 
nerve-trvmks supplying the operative field were cocain- 



ON THE BLOOD-PRESSURE IN SURGERY. 

ized. No noteworthy change in blood-pressure was 
noted. 




Fig. 65.— Chart HI. (Cushing). — Chart showing the alterations in the pulse and 
blood-pressure during an abdominal operation for tubercular peritonitis in a feeble 
child. 



In a typical Halstead operation for carcinoma of the 
breast no noteworthy changes occurred. (See Fig. 
66.) 

In a case of tubercular peritonitis in which the viscera 
were exposed and handled, the blood-pressure fell. 



ON THE BLOOD-PRESSURE IN SURGERY. 



357 



He has strikingly shown the value of blood-pressure 
determinations in the diagnosis of pressure upon the 
brain, and its value in making the prognosis in such 



0\ p: i $ 2 2 £5 ; i = t = !i t t i t t K 




Fig. 66. — Chart IV. (Gushing).— Chart showing pulse-rate and blood-pressure curves taken 
during a Halstead operation for carcinoma of breast. 



cerebral condition. His researches and writings 
gave a very great impetus to the blood-pressure 
work in this country. 



358 ON THE BLOOD-PRESSURE IN SURGERY. 

The influence of narcosis on the blood-pressure has 
been more fully determined by Kapsammer in obser- 
vations in eighty patients. In general it was found 
that the blood-pressure fell in narcosis, this being 
observed in seventy-five cases. This fall measured 
in most instances lo to 40 mm. In some cases, how- 
ever, 60 to 70 mm., and once even 120 mm. 
A distinct relation between the height of the blood- 
pressure before the administration of the anesthetics 
and the difficulty in narcosis could not be determined. 
Patients whose pressure registered 100 mm. before 
the anesthetic were just as hard to anesthetize as those 
with 180 mm. During the narcosis, however, the 
oscillations were in direct accordance with the course 
of the same. A rise in the pressure regularly oc- 
curred when the patient came out from under the 
influence of the anesthetic and also in vomiting and 
coughing. This rise generally averaged 20 to 30 
mm. 

ON THE HUMAN BLOOD-PRESSURE. 

Remarks. — In the first part of the series of observations upon 
the human blood-pressure the Gaertner tonometer 
was used, when Dr. Harvey Gushing, to whom most 
of the interest in blood-pressure work in this country 
is due, brought the Riva Rocci instrument to my 
attention. The latter instrument, especially with 
Gushing's modification, proved itself decidedly more 
practical. 

In estimating the clinical value of blood-pressure de- 
terminations, consideration must be given to the fol- 
lowing questions : Is there a normal standard of 
blood-pressure in the same species? How great are 
the individual variations? Are there variations of 
consequence in the same individual ? Are the causes 
of the individual variations such as will likely inter- 
fere with correct determinations? Have we the 



ON THE BLOOD-PRESSURE IN SURGERY. 3^9 

means of making accurate determinations of the hu- 
man blood-pressure? Are the variations in clinical 
cases of importance? 

On 100 dogs accurate arterial pressure under full an- 
esthesia was recorded. The minimum pressure was 
80; the maximum pressure, 170; the medium press- 
ure, 125. The weight of the animals and their blood- 
pressure bore no relation to each other. It was im- 
possible to estimate the blood-pressure of a given 
animal. Often a small cur showed a higher pressure 
than a Newfoundland, or a fox terrier higher than 
a bull dog. In continuous observations upon the 
blood-pressure of the same animal marked variations 
were noted. This was true in the animals in which 
ether anesthesia, morphin anesthesia, or curare was 
administered. It was not possible by the closest ob- 
servation to predict the changes at any moment. 
These normal changes in pressure varied from a few 
to 20 mm. Hg. In some instances the changes were 
abrupt; in others they were gradual. 
The duration of the changes varied. These varia- 
tions, which have been proved to be mainly vaso- 
motor, were prominent in the normal animal. After 
the blood-pressure had been reduced very considera- 
bly, the changes were less marked. The nearer the 
fatal point was reached in the fall of the blood-press- 
ure, the less marked were the changes ; but when the 
blood-pressure had fallen to such a degree that the 
vasomotor changes were not so marked, the effect 
of respiratory action upon the blood-pressure curve 
was increased. In some extreme instances in these 
low blood-pressures the variation during each respira- 
tory action was more than half that of the entire 
blood-pressure. 

The difference between the systolic and the diastolic 
pressure in normal animals varied greatly. In the 
development of shock the difference between the sys- 



ON THE BLOOD-PRESSURE IN SURGERY. 

tolic and the diastolic pressure was diminished ; that 
is to say, there was a decrease in the height of the 
pulse-wave. In asphyxia, in reflex inhibition, in the 
administration of saline infusion, in cerebral com- 
pression, the pulse-wave was increased in length. 
The most marked difference between the systolic and 
diastolic pressures occurred in the experiments in 
which saline infusion was rapidly administered after 
the animals had been reduced to a profound de- 
gree of shock or collapse. In making the blood- 
pressure determinations on normal individuals by 
means of the Riva Rocci and Gaertner instruments, 
very marked individual differences were noted. 
These differences not only appeared in different ages 
and psychic states, but also in subjects of the same 
age and under virtually the same conditions. To de- 
termine more accurately these differences, obs^va- 
tions were made on the innjates of the Protestant 
Orphan Asylum, in which the conditions were as 
nearly equal as could be obtained. Here individual 
variations were still marked. Similar results were 
obtained in blood-pressure determinations upon the 
aged. In making repeated determinations in the 
same individual, it was found that the physical state, 
such as exercise, the ingestion of food, sleep, fatigue, 
etc., all caused variations. The psychic state caused 
in some instances a variation of 40 or more mm. Hg. 
Fear, anxiety, self-consciousness, all caused a rise in 
the blood-pressure. While experimenting upon the 
pneumatic rubber suit it was very difficult to find any 
one not under an anesthetic who did not exhibit a 
marked rise in the blood-pressure while the suit was 
being applied, and before any pneumatic pressure had 
been exerted. These psychic changes were so marked 
that our observations on any except the anesthetized 
were not regarded as accurate. In following the 
blood-pressure under full anesthesia, when non-opera- 



ON THE BLOOD-PRESSURE IN SURGERY. 



tive procedures were in progress, considerable change 
was noted. Normal subjects, even in a quiet horizon- 
tal posture, without apparent cause showed variations, 
although usually slight. By giving close attention, 
the variation in pressure occurring with each respira- 
tory excursion could be occasionally noted. 
The accuracy of the various instruments thus far de- 
vised is only relative. This is particularly true in 
the determination of the diastolic pressure. The co- 
efficient or error is diminished with the increase in 
skill and experience in the use of the instrument. 



362 ON THE BLOOD-PRESSURE IN SURGERY. 



A STUDY OF THE CHANGES IN THE BLOOD-PRESSURE 
DURING SURGICAL OPERATIONS. 



Operations on the Head. 

Trephining. — Incising the scalp caused no notable change in 
the blood-pressure. Separating the periosteum over 
considerable area of bone by means of a periosteotome 
caused a slight irregularity. Cutting through the 
bone by means of a mallet and a chisel caused some 
irregularity, although no marked net change was 
noted. Irritation of the dura mater caused a fall with 
considerable irregularity. (See Fig. 67.) In an 
operation for securing hemorrhage from a branch of 
the meningeal, considerable manipulation was neces- 
sary. In order to control the hemorrhage during the 
removal of more skull, gauze was packed between the 
skull and dura some distance beyond the margin of 
the bone; this caused a very considerable fall in the 
blood-pressure. Exploring the brain by means of a 
slender probe for a tumor caused no appreciable 
change. (See Fig. 68.) A similar observation was 
made in exploring both lobes of the cerebellum in 
like manner for a tumor. The incision of the dura 
mater with a sharp knife caused no appreciable 
change. Sponging with pressure caused the most 
marked fall. 

In operations for the removal of the Gasserian gan- 
glion, the blood-pressure and the pulse showed 
marked variations without any considerable net 
change until the skull was opened. (See Figs. 69 
and 70.) 

In both cases in which these observations were made 
the common carotid artery was closed and the hem- 
orrhage up to the point of making the intracranial 



ON THE BLOOD-PRESSURE IN SURGERY. 363 




Fig. 67.— Chart V. — Operation upon the cranium. Note the irregular curve during the exploration 
of the dura mater for an extradural abscess. Note the rise in the blood-pressure and the fall in the 
pulse during the exploration which involved some pressure. 



364 ON THE BLOOD-PRESSURE IN SURGERY. 




ON THE BLOOD-PRESSURE IN SURGERY. 



365 




366 ON THE BLOOD-PRESSURE IN SURGERY. 




ON THE BLOOD-PRESSURE IN SURGERY. 367 



dissection was practically nil. Elevating the dura 
caused an irregular fall in the pressure and an in- 
crease in the pulse-rate. Separating with consider- 
able gentleness the branches and the body of the 
ganglion caused no marked change. Elevating the 
temporosphenoidal lobe in order to give room for 
the exposure and removal of the ganglion caused a 
marked rise in the blood-pressure and an almost cor- 
responding fall in the pulse-rate. These phenomena 
were strikingly shown in several of Cushing's cases. 
During this part of the operation, there was some 
oozing; against this adrenalin tampons were used. 
A considerable rise in blood-pressure in one case fol- 
lowed, due probably to absorption of adrenalin. In 
both cases the posterior root was entirely exposed in 
a clear field, so that the effect of evulsion might be 
noted. It was found in each case that when the root 
was entirely isolated and in clear view, the weight of 
the ganglion was sufficient to sever it. The most 
rapid fall in the blood-pressure in the cerebral group 
occurred in a case in which there was a rapid hemor- 
rhage from the meningeal artery, which was con- 
trolled by gauze packing. The combined effect of the 
hemorrhage, the irritation of the dura mater, and the 
pressure of the brain caused a rapid fall. The amount 
of shock in operations upon the head was proportion- 
ate to the manipulation, the pressure upon the brain, 
the hemorrhage, and the duration of the operation. 

Operations in the Mouth. 

In bloodless excision of the tongue, and in operations 
on the floor of the mouth, there was but little change 
in the blood-pressure or the pulse. 

Operations on the Neck. 

Tracheotomy. — Asphyxia caused a very marked rise in the 
blood-pressure and slowing of the pulse-rate. In 



ON THE BLOOD-PRESSURE IN SURGERY. 

one case the unusual opportunity presented itself of 
making observations upon the blood-pressure just be- 
fore and during the development of asphyxia. (See 
Fig. 71.) The blood-pressure rose abruptly from 150 
mm. to 220 mm. Hg. Immediately upon opening the 
trachea and producing artificial respiration, the blood- 
pressure fell to 140 mm. and the pulse became more 
rapid than normal. The character of the pulse, both 
as to quality and rate, underwent as rapid changes as 
the blood-pressure. 

Tracheotomy under cocaine in the absence of 
asphyxia is attended by no special changes in the 
blood-pressure. 

In laryngeal operations the mucosa and the superior 
laryngeal nerves were cocainized; under these con- 
ditions, opening the box of the larynx, explorations 
of the interior of the larynx, and even laryngectomy, 
caused no marked change in the blood-pressure. ( See 
Figs. 72 and 73.) In one instance, while dissecting 
out glands lying close to it, the superior laryngeal 
nerve was subjected to traction. This was attended 
by an immediate fall in blood-pressure and a marked 
slowing of the heart. Both were due to reflex in- 
hibition from mechanical stimulation. (See Fig. 74.) 
In one instance, a papilloma which filled the entire 
box of the larynx and extended up to and over the 
entire under surface of the epiglottis was removed 
without any marked change in the blood-pressure. 
In operations for the removal of tumors of the neck 
shock was proportional to the loss of blood, to the 
mechanical insult to the tissues, to the manipulation 
of certain nerve-trunks, and to the duration of the 
operation. In removing tumors of the parotid, it 
was found in two instances that while dissecting 
them out of their bed, in the deep angle behind the 
jaw, a marked and sudden fall in the blood-pressure 
and in the pulse-rate occurred. (See Fig. 75.) As 



ON THE BLOOD-PRESSURE IN SURGERY. 369 



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Fig. 71.— Chart IX.— Case of extreme asphyxia. Note the fall in the pulse-rate and the rise in the 
blood-pressure. Note the rapid recovery after tracheotomy. 
24 



ON THE BLOOD-PRESSURE IN SURGERY. 



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Fig 74 -Chart XII.— Phase showing the effect of an accidental severe manipulation of the supe- 
rior laryngeal nerve in a laryngectomy. Note the marked fall in the pulse-rate and in the blood- 
pressure. The nerve was then identified, cocainized, and severed, after which the pulse and pressure 
ran an even course, the pneumatic suit supporting the circulation. 



ON THE BLOOD-PRESSURE IN SURGERY. 



373 




Fig. 75. — Chart XIII. — Removal of tumor of the parotid. Note the fall in the pulse-rate and the 
blood-pressure during traction upon the territory traversed by the superior laryngeal nerve. After the 
striking evidence of inhibition through mechanic stimulation of this nerve, a more gentle dissection was 
made and cocain used, after which no further inhibition was noted. 



ON THE BLOOD-PRESSURE IN SURGERY. 



soon as the change was noted, the area was packed 
with cocain. After this, by more careful manipula- 
tion, and from the effects of the cocain, the tumors 
were removed without producing further depression. 
Excision of such muscles as the sternomastoid caused 
no marked change. Quick division of the vagus 
caused no effect upon the blood-pressure or pulse, but 
rough manipulation and traction caused a considerable 
fall. Observations were made upon eleven sections of 
the vagus. Dissections involving exposure and ma- 
nipulation of the sympathetic nerve-trunks caused an 
increase in the pulse-rate. Resection of the trachea 
and of the esophagus caused no marked change. 
There were no immediate effects following temporary 
or pennanent closure of the carotid artery. 
Observations upon the blood-pressure dining the re- 
moval of five branchiogenic carcinomata, in which all 
the structures above mentioned were removed en 
bloc, gave the opportunity for making the observa- 
tions. In removal of branchial cysts but little change 
in the blood-pressure was noticed. In operations for 
the removal of tubercular glands the amount of shock 
was proportional to the vitality of the patient, the 
duration of the operation, the amount of loss of 
blood, and the amount of mechanical irritation. 
In a case of sarcoma projecting from the thorax into 
the lower portion of the neck, exhibiting a misleading 
amount of mobility, removal was attempted. (See 
Fig. 76. ) It was not discovered, until the dissection 
had proceeded so far that hemorrhage underneath and 
behind the tumor could not be controlled, that it should 
have been regarded as an inoperable case. In pushing 
this dissection to its conclusion the clavicle was re- 
sected, the pleural cavity opened, and the brachial 
plexus partially removed. In this operation a rapid 
decline in the blood-pressure was noted. In the ma- 
nipulation for dislodging the tumor from its deep bed. 



ON THE BLOOD-PRESSURE IN SURGERY. 



01 o 

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ON THE BLOOD-PRESSURE IN SURGERY. 



the brachial plexus was roughly manipulated, several 
trunks severed, and great hemorrhage incurred. Dur- 
ing this time the blood-pressure fell rapidly to 68 mm. 
The pneumatic rubber suit was then inflated, bring- 
ing the pressure to no mm., at which point it was 
maintained during the remainder of the operation. 
In the removal of large tumors, in which hemorrhage 
was controlled by closing the carotid artery with a 
special clamp, in which a preliminary injection of 
atropin to protect against reflex inhibition of the 
heart was given, in which sharp dissection and gentle 
retraction instead of blunt dissection was largely 
made, and in which when branches of the vagus were 
involved inhibitory impulses were prevented by the 
use of cocaine, a comparatively small amount of 
shock was encountered. In all these serious opera- 
tions the rubber suit was put on before beginning, 
and, as occasion demanded, the blood-pressure was 
supported so as to be maintained at a certain level. 

Thorax. 

Excision of the breast for carcinoma in middle-aged 
subjects was attended by only moderate changes. 
The blood-pressure sometimes showed a decline 
towards the close of the operation and the pulse be- 
came proportionately accelerated. In an elderly pa- 
tient a marked fall was noted. ( See Fig. 77. ) 
In the complete dissection of the axilla, particularly 
when the large blood-vessels and the nerve-trunks are 
involved in the dissection, the principal change in the 
blood-pressure was noted, the net result of which was 
an irregular decline. 

Dissection with a sharp knife, with minimum traction, 
caused the least change. Rough sponging, blunt dis- 
section, and strong retraction caused the most marked 
change. Resection of ribs caused but slight change, 



ON THE BLOOD-PRESSURE IN SURGERY. 

though opening the pleural cavity caused a marked 
change. In operation for empyema, the opening of 
the cavity and the discharge of the pus were attended 
by a rapid fall in the blood-pressure and an increase 
in the pulse- rate. ( See Fig. 78. ) 

Abdomen. 

Observations were made during pylorectomy, partial 
gastrectomy, gastroenterostomy, enteroenterostomy, 
choledochotomy, cholecystotomy, cholecystectomy, 
appendectomy, resection of the cecum, and resection 
of the large and the small intestines. It was found 
that the amount of shock was directly proportional 
to the amount of traumatism inflicted upon the peri- 
toneum. The mucous membrane of the hollow vis- 
cera did not seem to be capable of producing shock. 
Exposure to the air, manipulation, and sponging 
caused a fall in the blood-pressure and a rise in the 
pulse-rate. This was noted in packing the abdominal 
cavity with gauze. (See Fig. 79.) Flushing out the 
cavity also caused a decline in the blood-pressure. A 
most marked effect was noted during the exploration 
of the abdominal cavity in the development of the 
field of operation, separating adhesions, and bringing 
tumors into the wound. 

In operations involving only a small segment of the 
intestine, although considerable time was occupied, 
there was little change in the pressure after the first 
effect had worn off. This was true only when the 
remainder of the peritoneal cavity was kept free from 
irritation, as, for example, during the application of 
the sutures in an anastomosis, but slight change in 
the blood-pressure was noted. The same is true in 
appendectomy. During the technique of the appen- 
dectomy but little change was noted. In operations, 
such as the dissection of gangrenous bowel in 
strangulated hernia, the extensive washing and 




Fig. 78. — Chart XVI. — Operation for empyema. Note the simultaneous increase in the pulse-rate 
and the fall in the blood-pressure. 



380 ON THE BLOOD-PRESSURE IN SURGERY. 




ON THE BLOOD-PRESSURE IN SURGERY. 



sponging of the field to remove infection was at- 
tended b}^ a considerable decline in the blood-press- 
nre. The manipulation which caused the changes 
in the blood-pressure in almost every instance caused 
an increase in the respiration. 

The Doctors Mayo, of Rochester, Minnesota, from 
their extensive clinic, made observations upon 
twenty-five cases of gall-stone operations in which 
the increase in the respiration and in the pulse-rate 
was noted. ( See Fig. 80. ) The pulse and the respi- 
ration were increased during the manipulation, par- 
ticularly while removing common duct-stones, and in 
exploration of the field. Observations upon the respi- 
rations and the pulse in my own cases of gall-stone 
operations corroborated these results. (See Fig. 81.) 
The most striking effects were noted in the operations 
in the upper portion of the peritoneal cavity near the 
diaphragm. The lower portion of the abdominal 
cavity showed less reaction. In all the abdominal 
operations above mentioned the net tendency of the 
changes was towards incline. In some instancs tem- 
porary rise appeared, but this usually gave way to 
greater decline. In the female genital organs observa- 
tions were made during operations for resection of the 
ovaries, the removal of ovarian tumors, excision of the 
tubes for pyosalpinx, myomectomy, hysterectomy, 
both abdominal and vaginal, dilating and curetting 
the uterus, and plastic operations upon the vagina 
and peritoneum. In almost every instance the im- 
mediate effect of manipulation of these organs was 
a rise in the blood-pressure. (See Fig. 82.) This 
rise usually continued during the period of manipula- 
tion, and was proportional to the traumatism adminis- 
tered. The most marked rise was noted in the case of 
large fibroid tumors, in which considerable difficulty, 
owing to impaction and adhesion, was experienced 
in raising the tumor from its bed. 



ON THE BLOOD-PRESSURE IN SURGERY. 



383 



I 




ON THE BLOOD-PRESSURE IN SURGERY. 




ON THE BLOOD-PRESSURE IN SURGERY. 



Similar results were noted in the different operations 
upon the perineum and vagina. Divulsion of the 
sphincter ani caused a very marked rise in the blood- 
pressure and some increase in the pulse-rate. (See 
Fig. 83.) The respirations were markedly increased 
in depth and rhythm. During the manipulation of 
the sigmoid, respiration was always increased, particu- 
larly its inspiratory phase. This also occurred in 
dilating the cervix. 

Genito-Urinary System. 

Blood-pressure determinations were made during 
nephrectomy, nephrotomy, nephrorrhaphy, and su- 
turing of the ureter. (See Fig. 84.) During the 
removal of large inflamed carcinoma of the kidney the 
blood-pressure fell rapidly. In nephrorrhaphy and 
incising the kidney thQ slight effects were noted. 

Testicles. 

In dissecting a firmly adhering sac of a scrotal her- 
nia, marked fall in the blood-pressure was noted. 
(See Figs. 85 and 86.) In excising the thickened 
hydrocele sac, the same was noted. (See Fig. 87.) 
In all manipulations, when any effect was noted, it was 
a fall. In amputation of the penis in an elderly subject 
the fall was marked. (See Fig. 88.) During careful 
dissection of the enlarged veins of a varicocele no 
effect was noted. 

Spinal Column. 

Blood-pressure determinations in two laminectomies 
under cocain anesthesia were made. Incising the 
skin, fascia muscles, and the bones caused no appre- 
ciable change in the pressure. On exposing and ex- 
ploring the membranes of the cord a marked fall in 
the blood-pressure occurred. ( See Fig. 89. ) 
In one case the exploration extended from the fifth 
25 



386 



ON THE BLOOD-PRESSURE IN SURGERY. 




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roborating general clinical observation and supporting former experimental evidence. 



ON THE BLOOD-PRESSURE IN SURGERY. 387 





Fig. 85.— Chart XXIII.— Phases of operation upon the testicles. 



ON THE BLOOD-PRESSURE IN SURGERY. 



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390 



ON THE BLOOD-PRESSURE IN SURGERY. 



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Fig. 87.— Chart XXV.— Phase of operation for neglected and inflamed hydrocele. Note tlie marked 
fall in the blood-pressure and a simultaneous increase in the frequency of the heart. The latter would 
tend to overcome the fall in the blood-pressure. The marked fall in the blood-pressure despite the in- 
crease in the frequency of the heart-beat supports the experimental evidence that the fall in the blood- 
pressure in traumatism of the testicle is due to a vasodilation through vasomotor influence. 



ON THE BLOOD-PRESSURE IN SURGERY. 




Fig. 88. — Chart XXVI. — Phase of an amputation of the penis for carcinoma in an elderly subject. 
Note the striking fall in blood-pressure during the actual amputation. The fall was but temporary. 
The high initial pressure is commonly found in aged subjects. 



ON THE BLOOD-PRESSURE IN SURGERY. 



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Fig. 89. — Chart .X.XVII. — Exploration of the spinal cord for a tumor. The initial blood-pressure 
was high owing to the influence of anxiety and fear. Note the marked fall in the blood-pressure and 
the increase in the pulse-rate when the dura was opened and there was free escape of cerebrospinal 
fiuid ; considerable manipulation was made. A compensatory rise immediately followed. 



ON THE BLOOD-PRESSURE IN SURGERY. 393 

cervical to the axis. It was found that the deep tis- 
sues of the back over the middle line have but few 
sensory nerves. No cocain was required in the di- 
vision of the deepest fascia, the separation of the 
deepest muscles, the division of the spinous processes 
and the laminae, and in exploration of the dura 
mater, with the exception of the points of exit of 
the sensory nerve-roots. 

The slightest contact with the sensory nerve-root 
caused an intolerable electric pain. There was quite 
a tendency to compensation in the blood-pressure 
following the fall upon opening the canal and making 
mechanical contact with the dura. 

Hernia. 

In operations for inguinal hernia no effect was noted, 
except in those in which there were adhesions of the 
sac to the spermatic cord, necessitating considerable 
manipulation. (See Fig. 90.) In such cases a fall 
in pressure was noted. This fall was probably due 
to the excitation of the characteristic depressor nerve 
mechanism of the part. In operation for ventral 
hernia no special changes in the blood-pressure were 
noted, except in the cases requiring considerable peri- 
toneal manipulation. 

Extremities. 

Stretching the sciatic nerve caused a marked and ir- 
regular rise in blood-pressure (see Fig. 91) and an 
increase in the pulse-rate. Operating on the soft 
parts caused an irregularity in the pressure, more par- 
ticularly a rise. Some of the cases of most profound 
shock were caused by heavy injuries of the limbs ; 
e.g., railway accidents. In an amputation of a shoul- 
der-joint, in which the trunks of the brachial plexus 
were cocainized, thereby " blocking" the afferent im- 
pulses, no material change in the blood-pressure was 



394 



ON THE BLOOD-PRESSURE IN SURGERY. 



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Fig. 90.— Chart XXVIII.— Herniotomy (Bassini). 



ON THE BLOOD-PRESSURE IN SURGERY. 





Fig. 91.— Chart XXIX.— Stretching the sciatic nerve for intractible neuralgia. Note the anesthetic 
fall (chloroform) then the abrupt rise from 132 mm. to 188 mm. The pulse-rate during the same period 
rose from 70 to 98. The decline after the stretching was almost as rapid as the rise. 



ox THE BLOOD-PRESSURE IN SURGERY. 




Fig. 92.— Chart XXX.— Operation for removing necrosed bone. Although the operation was extensive, 
the ne_t alteration in the blood-pressure and the pulse was not marked. 



ON THE BLOOD-PRESSURE IN SURGERY. 



397 



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Fig. 93. — Chart \ / XXXI. — Traumatic shock caused by mangling of the arm and shoulder in a 
railroad accident I i On admission the patient was in deep shock and rapidly increased. On admin- 
istering the anes- ^ thetic the blood-pressure fell and the radial pulse disappeared. The pneumatic 
suit was hastily put on and inflated. Note the rapid rise in the pressure. The brachial plexus was 
exposed, cocainized, then divided. Note the even blood-pressure tracing during the amputation owing 
to the " blocking" of the brachial plexus and the support of the circulation by means of the pneumatic 
suit. The patient recovered. 



ON THE BLOOD-PRESSURE IN SURGERY. 




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Fig. 94.— Chart XXXIl.— Curve of blood-pressure and pulse in a case of collapse (fainting) after 
an operation. The operation consisted in a removal of all the glands and the jugular vein on one side 
of the neck, and the superior cervical on the other side, together with an e.\cision of the tongue for 
carcinoma. The pneumatic suit had been used during the operation, but h?d been gradually deflated 
on returning the patient to bed. Owing to oozing in the hack part of the mouth, the patient was 
propped up in bed. He immediately fainted. The pneumatic suit was promptly inflated, bringing back 
consciousness very promptly without changing his posture. The suit was then allowed to remain 
several hours and gradually deflated. An assistant took rapid observations before, during, and after 
the faint. 



ON THE BLOOD-PRESSURE IN SURGERY. 



noted. In operations upon bone the blood-pressure 
showed comparatively small variation. (See Fig-. 
92.) The most marked variation was noted during 
procedures upon the periosteum. 

Operations under Cocain. 

In abdominal operations under cocain (see figure) 
not so much alteration in the blood-pressure was noted 
as in operations under general anesthesia. This was 
noted in an operation for typhoid perforation in a 
boy of twelve years ; in a case of cholecystectomy for 
gall-stones in a woman of seventy ; in two cholecys- 
totomies in young adults (see Figs. 80 and 90) dur- 
ing typhoid; in a gastrostomy with exploration of 
the esophagus ; in colostomy, and in other laparoto- 
mies. If there was momentary pain or fear, the blood- 
pressure usually rose irregularly. The less amount 
of shock in these operations under cocain was proba- 
bly due to several factors. There was no depress- 
ing effect of a general anesthetic; the operation did 
not necessitate much manipulation ; and the same 
precaution against the cause of pain — minimum ma- 
nipulation — was just as effective against shock. In 
the instances in which either pain or fear caused a 
rise in the blood-pressure a later decline was noted. 
Operations upon the area supplied by nerve-trunks 
subjected to cocain " block" produced no shock. (See 
Fig- 93-) Intrathoracico-scapular amputations in 
which the brachial plexus was " blocked" by cocain 
caused no shock. Collapse in laryngeal and other neck 
operations may be avoided by the proper use of cocain. 
Summary. — The estimations of the blood-pressure by means 
of a sphygmomanometer were certainly more accu- 
rate than the palpation of the radial pulse by the un- 
trained anesthetizer or the inexperienced interne. 
During important operations, and in the after-care of 
certain cases, blood-pressure determinations were fre- 



400 



ON THE BLOOD-PRESSURE IN SURGERY. 



quently of A'ital importance. In five cases of typhoid 
perforations suggestive changes were noted. In one 
the blood-pressure rose from 90 to 130 mm. in six 
hours. In a case of a child that was admitted as a per- 
foration the blood-pressure was 102 mm. ; following 
the operation for closure of the perforation the general 
peritonitis disappeared. The pressure then fell to 80 
mm. A second perforation occurred on the eighth 
day. The blood-pressure then rose from 82 to no 
mm. In another case of perforation the blood-press- 
ure was 165 mm. The fifth case registered a pressure 
of 210 mm. In view of the great variation in indi- 
viduals, a single observation is of but little diagnostic 
importance, but repeated observations may have some 
value. In 115 cases of typhoid the maximum press- 
ure was 1-38 mm. ; the minimum 70 mm. In the 
first week the mean pressure was 1 1 5 mm. ; dur- 
ing the second week, 106; the third, 104 mm.; the 
fourth, 96 mm. ; the fifth. 98 mm. As opposed to 
the effect of typhoid toxins, acute infective inflam- 
mation causes a rise in the blood-pressure. In 23 
cases of peritonitis in the height of the attack the 
minimum pressure noted was 145 mm. ; the maxi- 
mum, 210 mm. The average was 162 mm. Blood- 

NoTE. — In a personal communication. Dr. Briggs, of Johns Hopkins, 
referred to a case of typhoid perforation in which the two hundred or 
more previous blood-pressure determinations had well established the 
typical typhoid curve, and which suddenly rose from about no mm. Hg. 
to 144 mm., but on careful examination no other sj'mptom of perforation 
was found. Four hours later typical symptoms of perforation appeared. 
At operation a perforation was found. 

In another case in which there was sudden onset of symptoms of 
perforation — pain, tenderness, muscle spasm, leucocytosis, distention, drawn 
features, etc. — no change in blood-pressure was noted. The exploration 
did not reveal either perforation or peritonitis. 

These two cases under the direct notice of a skilled observer seem to 
me to be of great importance. They corroborate my own previous observa- 
tions and present even greater value than any of my own. The negative 
evidence in the second case seems quite as important as the positive in the 
first. 



ON THE BLOOD-PRESSURE IN SURGERY. 



pressure determinations in acute infective inflamma- 
tions show a rise. These determinations are of but 
little value in making a prognosis. In the later 
stages, in the unfavorable cases a rapid fall indicates 
impending dissolution, but at this stage other symp- 
toms indicate even more clearly the fatal termina- 
tion. As a means of diagnosis of infection in super- 
ficial parts, other symptoms are so much more marked 
and reliable that blood-pressure determinations may 
be dismissed as not adding to our means of diag- 
nosis. The blood-pressure of individuals varies 
within a wide range; for a number of causes blood- 
pressure in the same individual varies greatly. It is 
particularly difficult to eliminate the psvchical factor. 
It is frequently difficult to interpret the blood-press- 
ure readings when their indications are most needed. 
The methods of determining the pressure thus far 
devised are only relatively accurate. In surgical 
practice blood-pressure determinations have added ? 
new resource of a fair amount of practical value. 
The observations during surgical operations corre- 
spond very closely with those previously published as 
observed in experiments on animals. 

Argument. 

In shock the essential phenomenon is a diminution 
of the blood-pressure. Since there are no demonstra- 
ble lesions in the fatal cases, and no later effects in 
those that recover, we will assume exhaustion, rather 
than structural lesions, to be the cause of this fall. 
It must then be an exhaustion of the cardiac muscle, 
of the cardiac centres, of the blood-vessels, or of the 
vaso motor centres. 

Is it due to exhaustion of the cardiac mechanism? 
The heart as an organ is noted for the large amount 
of labor it may perform without fatigue. In shock, 
on account of the diminished blood-pressure, there 
26 



402 



ON THE BLOOD-PRESSURE IN SURGERY. 



is even less work for the heart muscle to do than 
in the normal state. In a series of experiments, after 
the animal had been reduced to a degree of shock 
presumably fatal, the blood-pressure was, by special 
means, raised much higher than the normal. The 
heart then performed its normal function. There 
was, then, no material fatigue of the heart muscle. 
Is it due to exhaustion of the cardio-inhibitory 
centre ? In experiments in which animals had been re- 
duced to a degree of shock presumably fatal the blood- 
pressure was by special means raised to the normal. 
Then on manipulation of the laryngeal mucosa a nor- 
mal reflex inhibition of the heart was induced. The 
cardio-inhibitory centre and its peripheral nerve 
mechanism were, therefore, not exhausted. That 
the cardio-accelerator mechanism remains active in 
every degree of shock is constantly evidenced by the 
increasing rapidity of the heart luitil the inauguration 
of the phenomena of death. In a series of experi- 
ments the heart was isolated from the nervous system 
by severing both vagi and both accelerantes. Shock 
in such animals was as readily produced as in the 
controls. We may then exclude the heart and its 
nerve mechanism as factors in the primary causation 
of shock and look to the loss of peripheral resistance 
as the essential factor. The loss of peripheral resist- 
ance may be due to (a) an exhaustion of the pe- 
ripheral nerve vascular mechanism, the anatomical 
periphery, or (b) an exhaustion of the vasomotor 
centres. 

In a series of experiments in which both vagi and 
both accelerantes had been severed, a physiologic dose 
of curare given, and artificial respiration main- 
tained, the animals were reduced to such a degree 
of shock that the vasomotor centre gave the usual 
physiologic proof of exhaustion. Varying doses of 
adrenalin were then given. The blood-pressure rose 



ON THE BLOOD-PRESSURE IN SURGERY. 403 

proportionally to the dose, even much higher than 
the normal. The same was also noted in the experi- 
ments in which the medulla and the cord were co- 
cainized or destroyed after such a degree of shock 
had been produced. Fatigue of the blood-vessels may 
then be excluded. That the vasomotor centres become 
exhausted in complete shock is indicated by the ab- 
sence of any rise in the blood-pressure on electrical 
stimulation of the sciatic nerve, or burning the paw. 
by giving a physiologic dose of strychnin, or by deep- 
est asphyxia, all of which cause stimulation of the 
normal vasomotor centres. Cocainizing the vaso- 
motor centres, or decapitation, causes a fall in the 
blood-pressure to about the same level as that of pro- 
found shock. We may then conclude that shock is 
an exhaustion or break-down of the vasomotor cen- 
tres. From this stand-point, then, let us consider 
the vasomotor stimulants, such as strychnin. 
In forty-eight experiments it was found that strych- 
nin in therapeutic doses did not, on the average, cause 
a rise in the blood-pressure. In another series in 
which the dose was gradually increased until the con- 
vulsive stage was reached a remarkable rise occurred. 
Was this rise due to the muscular contractions in the 
convulsions? No; since an equal or greater rise 
occurred when convulsions were prevented by pre- 
liminary injections of curare. Was the rise partly 
due to a simultaneous stimulation of the heart ? No ; 
since strychnin caused an equal rise in the blood- 
pressure in animals, in which both vagi and both 
accelerantes had been previously severed and a para- 
lyzing dose of curare given ; neither was an increased 
action noted on making direct observations on the 
heart, nor by noting the endocardial pressure. It 
was, therefore, a pure vasomotor stimidant. A bril- 
liant stimulant, indeed, sometimes doubling the nor- 
mal blood-pressure and lasting from thirty minutes 



ON THE BLOOD-PRESSURE IN SURGERY. 



to several hours. Each succeeding physiologic dose 
caused less effect, and after from two to four doses 
no appreciable effect was noted. The blood-press- 
ure in the mean time had fallen, and at last had 
reached the same level as in most profound shock. 
It was at this stage not possible by reactions, such 
as electric stimulation of the sciatic nerve, burning 
of the paw, by deepest asphyxia, nor by a study 
of the terminal tracings, to distinguish between 
these animals and the animals in profound traumatic 
shock. The vasomotor centre in each was exhausted. 
It was, in effect, shock produced by strychnin. The 
effect upon the function of the vasomotor centres 
seemed to be alike, whether the stimulation was 
mechanical and external, as in injuries or operations, 
or internal, as from strychnin. 

Conversely, in a series of experiments in which 
strychnin was given in various degrees of shock, in 
such dosage as to cause a stimulation, the effect was 
proportional to the degree of shock; that is, when 
but little shock was present a marked effect from 
strychnin was obtained; when most profound there 
was no effect. In the intervening degrees, the effects 
were proportional, but after giving strvchnin in physi- 
ologic doses the animals not yet in complete shock 
always passed into shock of a deeper degree. Later 
in the research it was found that the most convenient 
and certain method of producing shock for experi- 
mental purposes was by the administration of physio- 
logic doses of strychnin. It then follows that treat- 
ment of shock by vasomotor stimulants in the form 
of drugs is on precisely the same basis as treatment 
by burning the animal or crushing its paws, or by 
subjecting it to injury or operation. It would seem 
to be as reasonable to treat strychnin shock by ad- 
ministering traumatism as traumatic shock by strych- 
nin. 



ON THE BLOOD-PRESSURE IN SURGERY. 



What has been said of strychnin may be assumed 
to apply equally well in the case of other stimulants 
of the vasomotor centre. Turning, then, to cardiac 
stimulants, we must first consider how much influence 
an increase in the force and frequency of the heart- 
beats have upon the blood-pressure. Even in normal 
animals, when the peripheral resistance is at its best, 
an increase in the force and frequency of the heart- 
beats has but a limited power of increasing the blood- 
pressure. In a series of experiments in which the 
vasomotor centre was reduced to varying degrees of 
exhaustion, and the vagi severed, thereby increasing 
the force and frequency of the heart-beats, the rise 
in the blood-pressure sustained an inverse ratio to 
the degree of exhaustion; and in the case in which 
the vasomotor centre was entirely exhausted the 
blood-pressure was not raised by any increase in the 
force and frequency of the heart-beats. In the de- 
capitated animal the blood-pressure, unassisted except 
by artificial respiration and the elasticity of the ves- 
sels, falls to about lo to 15 mm. This represents 
even more than the cardiac factor in the maintenance 
of the blood-pressure. An artificial circulatory appa- 
ratus was arranged so that the peripheral resistance 
was represented by the atmospheric pressure in a 
cylinder which contained an elastic bag filled with 
water and communicating by means of tubing with an 
artificial heart on the outside. In this rough way the 
force and frequency of the heart-beats and the periph- 
eral resistance could be increased or diminished at 
will. It was not possible by any increase in the force 
and frequency of the artificial heart-beats to raise and 
maintain the mean artificial blood-pressure more than 
10 mm. The velocity of the circulation was, of course, 
much increased. On the other hand, any change in 
the peripheral resistance was attended by an equal 
change in the blood-pressure. From the stand-point 



ON THE BLOOD-PRESSURE IN SURGERY. 



of physics, as well as physiology, it would seem that 
the peripheral resistance (vasomotor action) fixes the 
gauge for the height of the blood-pressure, while the 
heart supplies the force necessary for circulating the 
blood. 

This would leave but a limited range of possibilities 
for heart stimulants. In another series of experi- 
ments cardiac stimulants were tested. It was found 
that as the peripheral resistance was lowered, the 
effect upon the blood-pressure was diminished, and 
when complete exhaustion of the vasomotor cen- 
tre existed the cardiac stimulants had but slight 
influence upon the blood-pressure. Other drugs 
which are, in practice, generally included in the 
class of stimulants, such as alcohol, nitroglycerin, 
and amyl nitrite, were studied at length. No justi- 
fication could be found for classifying these drugs 
as stimulants. In the case of alcohol, in not a single 
instance was there a sustained improvement in the 
blood-pressure or in the respiration. On the con- 
trary, the most constant and most marked effect upon 
the blood-pressure was a decline. The rapidity and 
the extent of the decline were proportional to the 
depth of the shock and the dosage of alcohol. In 
all the experiments upon nitroglycerin, when any 
effect was noted, it was an immediate fall in the 
blood-pressure. This occurred in every degree of 
shock. A compensatory rise equal to the fall in most 
instances followed. The rising curve was usually 
more gradual than the falling. Most of the animals 
showed a marked degree of toleration. On the 
whole, nitroglycerin acted unfavorably in shock. As 
in digitalis and alcohol, when considerable dosage 
had been given, the final break-down of the circula- 
tion was more sudden than in the control animals. 
If the foregoing be true, it is obvious that in true 
shock the use of stimulants acting upon the vaso- 



ON THE BLOOD-PRESSURE IN SURGERY. 407 

motor, the cardiac, and other centres of the medulla 
are, on the whole, either inert or harmful. In con- 
sidering other methods of controlling the blood- 
pressure, normal saline solution demands considera- 
tion. Normal saline administered intravenously or 
subcutaneously is a purely mechanical aid to the cir- 
culation, which temporarily increases the blood- 
pressure. The solution in any considerable quantity 
is not retained in the blood-vessels, but is eliminated 
at a rate proportional to the rate of administration 
through the same tissues that normally absorb water, 
mainly the alimentary tract. That the blood does 
not tolerate much dilution with normal saline was 
shown also by repeated observations upon the num- 
ber of corpuscles and the amount of hemoglobin 
during its administration. The accumulation of sa- 
line solution in the walls, and in the lumen of the 
stomach and of the intestines, in the peritoneal cavity, 
and in the liver, after approximately 320 c.c. per 
kilo had been given, caused so much additional dis- 
tention as to progressively hinder and finally prevent 
the excursions of the diaphragm and the movable 
ribs, causing death from respiratory failure. In the 
cases of pure shock — that is, in cases in which the 
vasomotor centres have been exhausted and no blood 
had been lost — the rise in the blood-pressure, even 
during its adAiinistration, if prolonged, was not sus- 
tained on account of the absence of the peripheral 
resistance and the elimination of the solution. Saline 
solution has a limited range of usefulness. It is ob- 
vious, then, that to increase and sustain the blood- 
pressure, when the vasomotor centre is exhausted, 
it is necessary to create a peripheral resistance either 
by a drug acting upon the blood-vessels themselves 
or by mechanical pressure. Adrenalin in the normal 
animal, or in any degree of shock, caused a marked 
and, in sufficient dosage, an enormovts rise in the 



ON THE BLOOD-PRESSURE IN SURGERY. 



blood-pressure. This rise occurred when the vaso- 
motor centres were proved to have been exhausted, 
when they were cocainized, and when they were de- 
stroyed. It occurred when, in addition, both vagi and 
both accelerantes had been severed and the animal 
was under the influence of curare. In larger doses 
a marked inhibitory action upon the heart was noted. 
This was immediately relieved by the injection of 
atropin. It was finally found that the most effective 
method of administration was by a continuous intra- 
venous infusion in salt solution, varying in strength 
from I to 50,000 or 100,000. After the experimental 
research seemed to have shown that adrenalin and 
salt solution thus administered could maintain the 
circulation with the heart isolated from the nervous 
system by section of both vagi and both accelerantes, 
with the vasomotor centre exhausted (complete 
shock), and with the muscular system paralyzed with 
curare, it followed that if these observations were 
correct a decapitated animal must be kept alive dur- 
ing a certain period of time. An ordinary laboratory 
dog was decapitated. Adrenalin and saline solution 
were immediately and continuously administered. 
It was found that the blood-pressure could be con- 
trolled at will. The beheaded animal lived ten and 
one-half hours, and finally died of air emboli pro- 
duced by the artificial respiration. On beheading 
animals, the primary fall in the blood-pressure was 
approximately the same as in profound shock. 
But one clinical application of adrenalin when the 
vasomotor centre was exhausted has been made. In 
this instance a patient who was dying was kept alive 
for ten hours by the continuous administration of 
adrenalin and the application of external pressure. 
It is to be remembered that, owing to rapid oxidation 
in the tissues, adrenalin is more effective when given 
intravenously, and, since it is even more rapidly oxi- 



ON THE BLOOD-PRESSURE IN SURGERY. 



dized in the blood, it should be given continuously. 
It is found to be most conveniently given in saline 
solution from a burette, the rate of flow being con- 
trolled by a screw^-cock attached to the rubber tube 
The circulatory phenomena should be under continu- 
ous observation. Great caution must be exercised in 
the administration of adrenalin. Its practicality has 
not yet been established. 

The therapeutic support of the blood-pressure in the- 
ory and in practice is at present unsatisfactory. 
In considering external pressure as a means of sup- 
plying a peripheral resistance, it is well to bear in 
mind that when the vasomotor centre is becoming 
exhausted, the blood-accumulates in the veins, espe- 
cially in the larger venous trunks. The condition 
may be described as an intravenous hemorrhage. 
Pressure applied uniformly upon the skin from the 
periphery towards the centre over an area containing 
such intravenous hemorrhage causes the blood to flow 
towards the heart, just as the normal vascular tone 
does. After numerous experiments, from water- 
baths to pneumatic chambers, in which it was at- 
tempted to devise a method of supplying an artificial 
peripheral resistance, a rubber pneumatic suit was 
found to be the most practical. The suit is made of 
a double layer of specially constructed rubber, and 
when inflated gives a uniform pressure upon the sur- 
face producing an artificial peripheral resistance. The 
inflation is accomplished by means of a bicycle-pump, 
and may be varied at will. Regardless of the posture 
of the patient, a considerable portion of the blood 
may be delivered to the right heart, preventing 
thereby, to a certain degree the continuance or de- 
velopment of cerebral anemia. By means of this 
suit the blood-pressure may be, within a range of 
25 to 60 mm. mercury, placed under the operator's 
control. The pneumatic suit has been employed in 



ON THE BLOOD-PRESSURE IN SURGERY. 



many clinical cases, and the effects studied by means 
of the Riva Rocci sphygmomanometer. 

Collapse. 

For the present purpose the term " collapse" is ap- 
plied to the cases of the more sudden fall of the 
blood-pressure from hemorrhage, from injuries of 
the vasomotor centre, or from cardiac failure. These 
conditions represent suspension of function rather 
than exhaustion of centres. There being no exhaus- 
tion, stimulants may be of value. As an illustration, 
if one animal is subjected to such a degree of shock 
(exhaustion of the vasomotor centre) as to produce 
a sufficient accumulation of blood in the veins (intra- 
venous hemorrhage) to cause a decline in the blood- 
pressure to 25 mm., and if another animal is sub- 
jected to an extravascular or ordinary hemorrhage, 
until the blood-pressure has been reduced an equal 
degree, it might be impossible, on the symptoms 
alone, to make a differential diagnosis. Yet, in the one 
case, stimulants could have no effect because the vaso- 
motor centres are exhausted, and in the other the 
effect might be marked because the centres are not 
exhausted. In the animal with the exhausted vaso- 
motor centres (or shock) saline solution could be of 
little assistance, but in the animal subjected to ordi- 
nary hemorrhage, and having normal vasomotor cen- 
tres, saline infusion might be of marked benefit. In 
collapse, mechanic, thermic, electric, or therapeutic 
stimulants, such as bruising, burning, application of 
electrodes, the administration of saline infusion or 
change of posture may be beneficial. 
After having considered the means of controlling the 
blood-pressure in cases in which there is exhaustion 
of the vasomotor centres (shock), and in cases in 
which there has been a temporary suspension of the 
function of the heart or of the vasomotor centres (col- 



ON THE BLOOD-PRESSURE IN SURGERY. 411 

lapse) , it remains to consider the control of the blood- 
pressure in cases in which the vasomotor, respira- 
tory, and cardiac centres, and the heart itself have 
all ceased to show any functional activity, — that 
is to say, when the animal is apparently dead. In 
a series of experiments, observations were made 
upon the use of electricity ; upon needling the heart ; 
upon massaging the heart ; upon making rhythmical 
pressure upon the thorax over the heart ; upon the 
injection of strychnin, adrenalin, digitalis, and other 
drugs into the chambers of the heart and into the 
heart muscle ; upon artificial respiration ; upon the 
administration of salt solution intravenously; upon 
rapidly alternating the posture of the animal, head 
up and head down, — all of these methods were em- 
ployed singly and in various combinations, but in 
no instance did we find it possible to resuscitate the 
animal after more than fifty-eight seconds after the 
last rhythmic contraction of the heart. 
The most favorable results were obtained by combina- 
tions of rhythmic pressure upon the thorax over the 
heart, artificial respiration, and intravenous saline in- 
fusion. Unless the heart and the vasomotor centre 
resumed action, the blood-pressure could be raised 
and sustained to but a very limited degree. During 
the experiments upon the decapitated dog it was ob- 
served that adrenalin acted upon the blood-vessels 
after the circulation had ceased. It was then planned 
to kill the animals by asphyxia, give artificial respi- 
ration, make rhythmic pressure upon the thorax over 
the heart, and at the same time administer adrenalin 
in saline solution into the jugular vein. By this 
means adrenalin might, through the feeble artificial 
circulation, be brought into contact with the walls 
of the blood-vessels, causing their contraction, 
thereby increasing the blood-pressure, which in turn 
might re-establish the coronary circulation, which in 



412 ON THE BLOOD-PRESSURE IN SURGERY. 

turn might re-establish the action of the heart. By 
this method animals apparently dead for various pe- 
riods up to fifteen minutes were restored to conscious 
life again. The circulation and the respiration in 
dogs electrocuted by a shock of 2300 volts of an 
alternating current were re-established. 

Final Summary. — In many instances the control of the blood- 
pressure is the control of life itself. Surgical shock is 
an exhaustion of the vasomotor centres. Neither the 
heart muscle nor the cardiac centres, nor the respira- 
tory centre, are other than secondarily involved. Col- 
lapse is due to a suspension of the function of the 
cardiac or of the vasomotor mechanism, or to hem- 
orrhage. In shock therapeutic doses of strychnin 
are inert. Physiologic doses are dangerous or fatal. 
If not fatal, increased exhaustion follows. There 
is no practical distinction to be made between ex- 
ternal stimulation of this centre, as in injuries and 
operation, and internal stimulation by vasomotor 
stimulants, as, for example, strychnin. Each in suf- 
ficient amount produces shock, and each with equal 
logic might be used to treat the shock produced by the 
other. Stimulants of the vasomotor centre are con- 
traindicated. In shock cardiac stimulants have but 
a limited range of possible usefulness, and may be 
injurious. In collapse stimulants may be useful be- 
cause the centres are not exhausted. 
Saline infusion in shock has a limited range of use- 
fulness; in collapse it may be effective. The blood 
tolerates but a limited dilution with saline solution. 
Elimination takes place through the channels of ab- 
sorption. Its accumulation in the splanchnic area 
may be sufficient to fix the diaphragm and the mova- 
ble ribs, causing death by respiratory failure. Saline 
infusion in shock raises but cannot sustain the blood- 
pressure. 



ON THE BLOOD-PRESSURE IN SURGERY. 413 

Adrenalin acts upon the heart and the blood-vessels. 
It raises the blood-pressure in the normal animal ; in 
every degree of shock; when the medulla is cocain- 
ized, and in the decapitated animal. It is rapidly 
oxidized by the solid tissue and by the blood. Its 
effects are fleeting; it should be given continuously. 
By this means the circulation of a decapitated dog 
was maintained ten and one-half hours. In excessive 
dosage there is a marked stimulation of the cardio- 
inhibitory mechanism. Due caution must be exer- 
cised. Its clinical value still remains unproved. 
The pneumatic rubber suit provides an artificial pe- 
ripheral resistance without injurious side effects, and 
gives a control over the blood-pressure within a range 
of from 25 to 60 mm. mercury. By the combined 
use of artificial respiration, rhythmic pressure upon 
the thorax over the heart, and the infusion of adre- 
nalin, animals which were apparently dead as long 
as fifteen minutes were resuscitated. 
By the same method, with the addition of the rubber 
suit, a patient who, from fatal injury of his brain, had 
been conventionally dead for nine minutes was par- 
tially resuscitated for thirty-two minutes, during 
which a strong heart-beat was noted and he was able 
to move his head. 



INDEX 



A 

Abdomen, operation upon, 378 
Abdominal cavity, irrigation of, 378 
Abdominal pressure, 206, 207, 210, 211. 
Abel, 270. 

Absorption, effects of pneumatic pressure upon, 286. 

Accelerantes severed, 87, 93, 96, 98, 100, 105, 107, no, 115, 117, 119, 120, 121, 

123, 127, 133, 152, 153, 154, 299. 
Adenitis, operations for, 374. 

Adrenalin, 82, 94, 96, 98, 99, 132, 133, 134, 150, 155, 156, 158, 159, 162, 165, 
166, 172, 220, 245, 246, 247, 248, 249, 250, 251, 252, 253, 259, 270, 299, 300, 
402, 408, 409, 411, 413. 

Alcohol, 13, 14, 15, 22, 28, 29, 30, 31, 82, 90, 115, 134, 136, 140, 141, 145, 147, 
149, 150, 261, 406. 

Amand, 291. 

Amyl nitrite, 31, 34, 41, 43, 406. 
Anesthetics, 359. 
Annotation, 11. 
Aorta, abdominal, 32. 
Aortic pressure, 204. 
Argument, 401. 

Arteriosclerosis, 351, 352, 353. 

Asphyxia, 42, 43, 72, 73, 87, 214, 245, 246, 247, 248, 249, 250, 251, 252, 253, 

257, 258, 403. 
Aspiration of ascitic fluid, 354. 
Aspiration of pleuritic fluid, 354. 
Atropin, 96, 152, 156, 248. 

B 

Bain, 336. 
Barger, 275. 

Barometric pressure, 241. 

Basch, 300, 314, 315, 317, 321, 322, 327, 331, 335, 336, 339, 343, 345. 
Bernard, 301, 306, 307, 312, 322. 
Biedl, 275. 

Blood-pressure, methods of determining : 
Basch, 301. 
Faiver, 313. 
Gaertner, 310, 324. 
Gumprecht, 318. 
Hill and Barnard, 306, 312. 

415 



4i6 



INDEX. 



Blood-pressure, methods of determining : 
Hoepfle, 304. 
Hurthle, 303. 
Oliver, 307. 

Recklinghausen, 313, 318. 
Riva Rocci, 306. 
Stanton, 312. 
Vierordt, 313. 
Zadeck, 313, 317. 
Boeri, 328. 

Brachial plexus, manipulation of, 376. 

Brain, surgical operations on, 362, 367. 

Breast, amputation of, 356. 

Breuer, 300. 

Briggs, 354, 400. 

Brown, 301. 

Brown, W., 5. 

Brunton, 355, 356. 

Brush, 321, 322. 

C 

Cardiac breakdown, 54. 

Cardiac disease, 345, 346, 347, 348, 353. 

Cardiac muscle, 401. 

Cardiac stimulants, summary of experimental evidence, 405, 406. 

Cardio-inhibitory centre, 150, 402. 

Cardio-inhibitory centre in shock, 94. 

Chloroform death, 94. 

Cholecystectomy, 378. 

Cholecystotomy, 378. 

Choledochotomy, 378. 

Christeller, 327. 

Circulation, changes in intracranial, 207. 
Circulation, effects of blood-pressure upon, 282. 
Circulation, effects of pneumatic pressure upon, 175. 
Circulation, effects of rarefied air upon, 211, 213. 
Circulation, effects of various forms of pressure upon, 175. 
Circulation, intracranial, effects of pneumatic pressure upon, 188, 189, 196, 
197- 

Circulation, mechanical support of, 107, 120, 134, 136, 137, 140, 141, 142, 147, 
148, 189, 190, 191, 288. 

Circulation, pneumatic support of, 92, 176, 177, 178, 179, 180, 181, 184, 185, 
186, 189, 193, 194, 196, 197, 198, 205, 206, 209, 210, 211, 213, 214, 218, 220, 
221, 223, 225, 226, 227, 229, 230, 231, 236, 237, 239, 240, 242, 243, 244. 

Circulatory apparatus, description of, 405. 

Cleghorn, 279. 

Cocain, 116, 170, 173, 174, 299. 

Cocain effects upon convulsions, 116, 117, 118. 

Cocain, operations under, 399. 



INDEX. 



Cocainization of medulla, 166, 168, 170, 299. 
Cocainization of spinal cord, 170. 
Cocainization of vagi, 173. 

Collapse, 87, 93, 110, IIS, 209, 255, 256, 297, 299, 410, 412. 
Colombo, 332. 

Convulsions, strychnin, 63, 68, 70, 72, 76, 78, 79, 92, 114, 116, 134, 140, 144, 

146, 147, 148, 166, 168, 170, 171, 172. 
Cook, 354. 
Cudell, 5. 

Cufif, blood-pressure determinations in various sizes of, 223, 334. 
Cushing, 306, 327, 355, 356, 357, 358, 367. 
Cybulski, 275. 
Cyon, 274, 277. 
Cystadenoma of ovary, 355. 

D 

Decapitation, 158, 159, 162, 165, 220. 

Differential pneumatic pressure, 284, 285, 201, 202, 203, 219. 

Digitalis, 44, 47, 48, 49, 50, 52, 57, 82, 107, 109, 115, 137, 139, 141, 142, 143, 

144, 145, 146, 147, 148, 149, 150, 151, 152, 158, 159, 24s, 246, 247, 248, 263, 

411. 

E 

Eckert, 327, 331. 
Entero-enterostomy, 371. 
Ewald, 322. 

Exercise, 335, 336, 337, 338, 341. 
Extremities, operations upon, 393. 

F 

Faiver, 313. 
Fedener, 328. 

Fever, 342, 343, 344, 345- , 
Food, 332, 333. 
Ford, 5. 
Frankel, 273. 
Furth, 270. 

6 

Gaertner, 301, 310, 324, 327, 329, 339, 354, 358. 
Ganglia, stellate, 172, 173, 174, 282. 
Ganglion, gasserian, 355, 362. 
Gastrectomy, 378. 
Gastro-enterostomy, 378. 
Genitalia, female, 382. 

Genito-urinary system, operations upon the, 385. 
Giles, 291. 

Gottlieb, 272, 274, 276, 278. 
Grebner, 329, 339. 
Gumprecht, 318, 328, 340. 

27 



4i8 



INDEX. 



H 

Heart as a factor in blood-pressure, 152, 269. 

Heart, effect of reflex inhibition on blood-pressure, 145, 150, 154, 300. 

Heart, extrinsic nerves severed, 152, 153, 154. 

Heart, rhythmic compression of, 246, 248, 249, 250, 411. 

Heath, 5. 

Hedon, 291. 

Hein, 342. 

Hemadynamometer, 307. 
Hemorrhage, no, 202, 239, 240. 

Hensen, 320, 321, 322, 324, 328, 332, 334, 347, 349, 351. 
Hernia, 378. 
Herniotomy, 393. 

Hill, 301, 306, 307, 312, 322, 336, 339, 340. 
Hochhaus, 328, 347. 
Hoepfle, 301, 304. 
Howell, 321, 322. 
Huber, 328. 

Hurthle, 301, 302, 303, 314, 335. 

I 

Intra-abdominal pressure, 185, 186, 190. 

Intracranial pressure, 186, 188, 190, 191, 193, 194, 198, 199, 205, 206, 207, 

209, 210, 211. 
Intrathoracic pressure, 190, 198, 206, 210, 211. 
Introduction, 9. 

J 

Jellineck, 328, 331, 333. 

K 

Kidney, chronic parenchymatous nephritis, blood-pressure in, 350. 
Kidney contracted in blood-pressure, 349, 350. 
Kries, 300. 
Kuliabio, 292. 

L 

Lakeside, 5, 287, 288, 295. 
Langendorff, 291, 292. 
Langlois, 272. 
Laparotomies, 354. 
Laryngeal explorations, 368. 
Laryngeal operations, 368. 
Larynx, cocainization of, 368. 
Larynx, irritation of, 134, 150, 166. 
Larynx, stimulation of, 300. 
Lenhart, 5. 

Ligation of carotid arteries, 205. 
Ligation of vertebral artery, 205. 
Lower, 5. 



INDEX. 



419 



Marcy, 300. 
Masing, 320, 338. 
Maxinowitsch, 335, 336. 
Mayo, 382. 

Mechanical support of circulation, bandaging, 107, 120, 134, 136, 137, 140, 

141, 142, 147, 148, 189, 190, 191, 288. 
Mechanical support of circulation, pneumatic, 92, 176, 177, 178, 179, 180, 

181, 184, 185, 186, 189, 193, 194, 196, 198, 205, 206, 209, 210, 211, 213, 214, 

218, 220, 221, 223, 225, 226, 227, 228, 229, 230, 231, 236, 237, 239, 240, 242, 

243. 244. 

Medulla, cocainization of, 166, 168, 170, 299. 
Miles, 273. 
Morphin, 281. 
Mosso, 301, 335, 336. 

Mouth, effect of operations on blood-pressure, 367. 
Mueller, 329. 
Muhlberg, 273. 

N 

Neck, operations upon, 367. 
Neck, tumors of, 368, 374. 

Nitroglycerin, 31, 32, 34, 36, 37, 38, 39, 40, 41, 84, 89, 116, 118, 406. 

0 

Oliver, 270, 271, 275, 301, 307, 322, 330, 331, 332, 336, 339, 340. 
Osseous system, operations on, 355. 

p 

Peripheral, 402. 

Peritonitis, tubercular, 354, 355, 356. 

Physiological variations in blood-pressure, 334, 335. 

Pleural cavity, opening up of, 378. 

Pneumatic apparatus, descriptiorl of, 175. 

Pneumatic pressure, effect of, upon the circulation, 382. 

Pneumatic rubber suit, 288, 376, 413. 

Potain, 321, 347, 349, 354. 

Pressure, differential, 284, 285. 

Pressure, diminished, 284. 

Pressure, effects of, upon absorption, 286. 

Pressure, effects of simultaneous alterations of, 287. 

Pressure, increased, 283. 

Pressure, intra-abdominal, 185, 186, 190. 

Pressure, intracranial, 186, 188, 190, 191, 193, 194, 198, 199. 

Pressure, intrathoracic, igo, 198. 

Pressure, mechanical, 288. 

Pressure, pneumatic, 92, 176, 177, 178, 179, 180, 181, 184, 185, 186, 188, 189, 
193, 194, 196, 198, 201, 205, 206, 207, 209, 210, 211, 213, 214, 217, 218, 220, 
221, 223, 225, 226, 227, 228, 229, 230, 231, 232, 234, 236, 237, 239, 240, 
241, 242, 243, 244, 409. 



420 



INDEX. 



Pressure, pneumatic, in treatment of shock, 189, 193. 
Pressure, rhythmic upon thorax, 246, 247, 248, 249, 251. 
Psychical processes, effects on blood-pressure, 340, 341, 342. 
Pulse-wave, 213, 214, 217. 
Pylorectomy, 378. 

E 

Radziejewski, 273, 274. 
Ray, 301. 
Reichert, 273. 

Remarks upon blood-pressure, 360, 361. 
Resection of cecum, 378. 
Resection of large intestine, 378. 
Resection of small intestine, 378. 
Resection of trigeminus nerve, 355. 
Respiration, artificial, 130, 136. 
Respiration, failure of, 60. 
Rest, effects of, upon blood-pressure, 339. 

Resuscitation, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 

258, 291, 294. 
Resuscitation, preliminary statement, 291. 
Resuscitation, previous research, 291. 
Riedner, 336. 

Riva Rocci, 301, 304, 305, 306, 307, 318, 322, 323, 324, 328, 329, 338. 



S 

Sahli, 328. 

Saline infusion, 57, 69, 84, 85, 86, 91, 98, 99, 105, 117, 118, 130, 132, 136, 177, 
180, 220, 223, 22s, 232, 233, 234, 235, 237, 238, 239, 257, 258, 269, 298, 407, 
408, 409, 410, 411, 412. 

Sarcoma, removal of, 374. 

Schule, 329, 334, 339, 340, 345, 353. 

Shock, 49, 50, 52, 54, 57, 60, 61, 64, 6s, 67, 69, 70, 73, 75, 79, 83, 84, 89, 90, 
91, 92, 96, 98, 100, 105, 107, 109, 112, 115, 118, 119, 120, 121, 123, 124, 129, 
130, 132, 133, 134, 152, 153, 154, 157, 173, 175, 177, 189, 190, 191, 193, 197, 
198, 210, 211, 216, 218, 220, 221, 227, 229, 230, 231, 232, 241, 243, 244, 24s, 
298, 401, 402, 403, 404, 406, 407, 408, 410, 412, 413. 

Shock, traumatic nature of, 298, 299. 

Shock, treatment of, by means of pneumatic pressure, 189, 193, 214, 215. 
Simultaneous alteration of blood-pressure, effect of, 287. 
Sollman, 5. 
Sommerfeldt, 329. 

Sphygmomanometer, description of : 
Basch, 301. 
Faiver, 313. 

Hill and Barnard, 306, 312. 
Hoepfle, 304. 



INDEX. 



421 



Sphygmomanometer, description of : 
Hurthle, 303. 
Riva Rocci, 304. 

Riva Rocci, Cushing's modifications of, 306. 

Stanton, 312. 

Zadeck, 313. 
Spinal column, operations on, 385, 393. 
Spinal cord, cocainization of, 170. 

Spinal cord severed, 158, 177, 180, 223, 226, 233, 234, 235, 238, 239, 245. 
Splanchnic circulation, 119. 
Splanchnic nerve, stimulation of, 100. 
Ssymonovfc'icz, 371, 375. 

Stanton, 301, 304, 311, 312, 321, 322, 330, 336. 
Stimulants, mixed effects of, 60, 83, 89, 90, 91, 92, 412. 
Strauss, 330, 334. 

Strychnin, effects of, in collapse, 87. 

Strychnin sulphate, 60, 64, 65, 66, 67, 68, 69, 70, 72, 73, 75, 76, 77, 78, 79, 82, 
84, 87, 94, 96, 98, 99, 100, 104, 105, 107, 109, no, 112, 113, 114, 115, 116, 
117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 129, 130, 131, 132, 133, 
136, 137, 139, 140, 142, 143, 144, 145, 146, 147, 148, 159, 166, 168, 170, 258, 
260, 298, 299, 403, 404, 405, 411. 

Stewart, 5, 294. 

Summary, 399. 

Summary, final, 412. 

Sympathetic nerve trunks exposed in manipulating, 374. 



T 

Table of blood-pressure under varying conditions, 325. 
Takamine, 270. 
Telich, 273. 

Testicles, operations upon, 385. 

Thorax, rhythmic pressure upon, 246, 247, 248, 249, 251. 
Tonometer, description of, 310. 
Tracheotomy, 367, 368. 
Trephining, 362. 
Tshcelinoff, 320, 335. 

V 

Vagi, cocainization of, 173. v 

Vagi, severed, 87, 96, 98, 100, 105, 107, no, 115, 117, 118, 119, 120, 121, 123, 

127, 129, 133, 134, 152, 153, 154. 15s, 156, 158, 299, 374. 
Vardier, 273. 

Vasomotor centre, 96, 401, 402, 403, 404, 405, 406, 407, 408, 409, 410, 411, 
412. 

Velich, 276, 278. 
Vierordt, 313. 



422 



INDEX. 



W 

Wagner, 340. 

Waldenburg, 301, 321. 

Weiss, 329, 334, 339, 347, 350, 352. 

Wetzel, 343. 

Z 

Zadeck, 313, 317, 322, 327, 331, 332, 336, 339, 342. 
Ziemssen, 327. 



FINIS.